Prolonged birth - A mystery of delivery room

”Never let the sun rise twice over a delivery”

African proverb

Giving birth is not a science, and few deliveries happen the same way. Some deliveries just take longer than others. The question is when long becomes too long.

Two out of five women giving birth for the first time will have a much prolonged delivery. The birth can have a slow start or stall midway. Some women even have contractions, but they result in little progress in the cervix.

Arrested labour is little understood in the medical profession, and often not discussed with women who are about to give birth, but there is a clear connection between prolonged birth and negative experiences of the delivery for the woman.

Support needed

The risk of a stalled labour increases for women who give birth for the first time or have a higher BMI, for larger babies, or babies with an unusual position in the womb. Prolonged labour can be connected with a higher experience of pain for the birthing mother, and usually lead to a higher usage of epidurals, which in themselves can prolong labour even further.
Studies show that one third of all women with arrested labour are reporting a negative birthing experience, and two thirds report that this experience had long term consequences. All in all, women who experience a prolonged labour are in strong need of competent human and medical support and knowledge, to feel safe during the challenging delivery.
But how can you tell if the labour actually is becoming “extra long”?

Usually a delivery is divided into three stadiums. In the first stadium, the delivery begins slowly with the early latent phase. The cervix thins and starts opening up to 4-6 cm. You can feel menstrual-like cramps, and sometimes an intermittent or permanent backache.

Strong emotions

Emotionally the woman can be in many places at once-tense, excited, worried, and talkative. The delivery is finally starting-or is it? This phase can take a few hours for experienced mothers, but in some cases last for 2-3 days for women giving birth for the first time.

During the next phase, the active phase, the contractions become more concentrated and more painful. Emotionally you might feel tenser, absorbed in your labour and the heavy work and pains it causes you to manage. The contractions might come with a couple of minutes in between, and last up to one minute each, like strong waves. The uterus will open to 7-8 cm. This phase will usually take 2-5 hrs, but can also take longer.

“I want to go home!”

During the final phase, called the transitional phase, you will find perhaps the most demanding part of the delivery. The cervix opens up the final centimetres, the contractions are long and very intense.

You might feel at your most vulnerable, and feel that this will never work, that your energy is waning. Some women sweat, get cramps and some even want to go home! But all these intense feelings and symptoms mean that the time is near. This phase can last for 15 minutes up to 3-4 hours, and sometimes longer the first time a women gives birth.
Under stadiums 2 and 3 the child is born with its afterbirth, the placenta.

A prolonged or stalled labour usually occurs during stadium one. The early labour has problems manifesting itself and getting started. Or it starts and slows down during the active phase. One indicator health care professionals might use is for the cervix to dilate 1 cm per hour. Slower progress than that would indicate an arrested labour. But there are also other definitions of exactly what constitutes a prolonged labour and what constitutes normality when it comes to giving birth.

A prolonged labour can end in two ways. In many cases, the women will give birth vaginally, read more about it here. But in other cases there will be an acute caesarean, read more about it here.