Understanding Prolonged Labor and the Risks Involved

The length of a woman’s labor and delivery is fodder for movie scripts and jokes.

A woman shouts, “I was in labor with you for 36 hours!” The audience laughs.

But prolonged labor is no joke. It is a labor complication that carries real risks for you and your baby. When managed carefully, both you and your baby will begin your journey in full health – if not a little later than planned. However, if your medical team isn’t on the ball, the risk of preventable injuries increases.

The consequences of prolonged labor gone wrong can be devastating for families.

What is prolonged labor, and what happens if your labor stalls? Here’s what every expectant mother should know about labor that lasts more than 20 hours.

What is Prolonged Labor?

Prolonged labor occurs when a woman’s labor progresses too slowly or even stalls. Doctors also refer to it as a “failure to progress” in labor or delayed delivery.

 On average, it occurs between 18 and 24 hours after regular contractions begin. You are likely in prolonged labor if you are giving birth for the first time and don’t deliver after 20 hours of contractions.

If you have delivered other children, doctors may start counting at 18 hours. If you are carrying more than one baby (twins, triplets, etc.), then prolonged labor begins earlier at 16 hours after the contractions start.

Who is at Risk?

Prolonged labor is predictable in some cases. For example, if your baby is very big or in an abnormal position, you are more likely to experience prolonged labor. A small birth canal is another risk factor.

Additionally, if you go into labor and your contractions are very weak, it may be a sign of eventual prolonged labor.

What Happens if Your Medical Team Suspects Prolonged Labor

When a woman’s labor slows or becomes prolonged, her medical team first checks her contractions.

The number and frequency of your contractions and the strength of your contractions indicate the stage of your labor. Weak and few contractions are the first sign of prolonged labor.

One way of measuring the exact strength of your contractions is with an Intrauterine Pressure Catheter Placement (IUPC). It gives the doctor a precise picture of your contractions and informs their next movements.

They should also perform continuous electronic fetal monitoring (EFM) to keep a record of your baby’s heart rate. 

The results of these assessments determine whether your doctor believes you should wait for natural labor to speed up or whether they feel the need to artificially speed up labor using Pitocin. They may even determine that you need a cesarean section (C-section) at this point.

If your team determines your birth canal is too small to safely deliver, or there is a risk to the baby, then you will very likely be recommended for a C-section right away.

Potential Risks Caused by Prolonged Labor

Prolonged labor is dangerous for both mother and baby. Labor that becomes stalled can result in:

• Abnormal heart rhythms
• Low oxygen levels
• Infection
• Unusual substances in amniotic fluid

These risks are why your team begins EFM when they suspect prolonged labor.

Among women, prolonged labor increases the risk of both hemorrhaging and infection.

Stalled labor also increases the likelihood of an eventual C-section. A C-section speeds up the birth and lowers the risks associated with the low oxygen levels and potential for infection.

Making a Timely Decision is Critical During Prolonged Labor

Long labor feels as though it will last forever, but your medical team still needs to make decisions quickly. 

The prominent advice provided by both medical teams and advocacy groups is to hurry up and wait.

Women are encouraged to take a warm bath, have a nap, or take a walk. In other words, relax and wait until your body does what it was designed to do. If a prescription (like pain medication) slowed your contractions, you will likely be instructed to wait until it leaves your body.

However, if labor doesn’t progress, then physicians need to be ready to make a decision. Allowing natural birth to continue on too long increases the health risks for both you and your child.

And avoiding a decision increases the chances that labor will go wrong. 

None of this even contends with the issue of the diverse definitions of prolonged labor, which result in inappropriate treatment.

When Labor Can Go Wrong: The Issue of Negligence

Some birth injuries are tragedies that no one could have predicted or prevented. However, others are of things going wrong when your medical team doesn’t carefully manage and watch over your prolonged labor. In other words, medical negligence can also cause birth injuries.

Medical negligence occurs when a medical team:

• Fails to use the right tests
• Fails to monitor the baby’s progress
• Fails to notice fetal distress
• Fails to order a C-section
• Distributes a medication improperly
• Uses a forceps, vacuum, or another tool improperly

For example, doctors use Pitocin to speed up labor for women experiencing stalled labor. However, Pitocin also comes with risks: if administered in too high a dose or given incorrectly, it can over-correct and result in excessive uterine contractions (tachysystole). Just as long labor risks a baby’s oxygen supply, so too does too many contractions.

An incorrect dose or administration of Pitocin can be an example of medical negligence.

Additionally, a delayed C-section risks brain damage, cerebral palsy, and hypoxic-ischemic encephalopathy (HIE). Doctors who fail to order a C-section or emergency C-section soon enough increase those risks as well as the risks to you, the mother. 

What to Do After a Prolonged Labor

By the end of 20-plus-hour labor, most mothers are ready to spend time with their new family – and have a nap. 

If you had prolonged labor and you or your baby experience a birth injury, then your hours in the delivery room will stay with you for a long time. The impacts of your labor may well follow you for a lifetime. Both the injury and the related costs can be significant for any family.

Did you experience prolonged labor and believe something went wrong? Get in touch today for a free consultation and to learn about what comes next.