Pregnancy - Why Is This Taking So Long? When Labor Stalls Out : Women-care

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Waiting for labor to start can feel like torture — overanalyzing every twinge in your body, trying every natural induction technique you can find, and reporting to friends and family that, yes, you are still pregnant! When it finally does start, you can only hope this is the real thing and you won’t experience stalled labor.

This was me toward the end of pregnancy with my first baby. My due date came and went, and I was left wondering whether your body or the baby decides when labor starts. As it turns out, research isn’t totally clear, but it’s likely a combination of aging cells in the amniotic sac, fetal lung maturity, and decreased effectiveness of the pregnancy-sustaining progesterone.¹

When my contractions finally started at 40 weeks three days, I thought this must be it. We drove to the hospital when my contractions were three minutes apart, just to discover I was only 3 cm dilated. Even worse, my contractions spaced out and became less intense once we got there. I was experiencing stalled labor, which I hadn’t really considered as a possibility! Pregnant women should know about stalled and prolonged labor, so let’s dive into its definition, causes, risks, and interventions.

What Is Stalled Labor?

Stalled labor is also called prolonged labor or labor dystocia. It happens when regular, intense uterine contractions stop spontaneously, fade out, or don’t progress.^1,2

The first stage of labor is divided into two stages: the latent phase and the active phase. The latent phase begins when contractions become regular and continues until you reach 6 cm of cervical dilation. The active phase begins when the cervix has reached 6 cm of dilation and continues until 10 cm dilation.² Stalled labor, also known as arrested labor, is officially defined as lack of cervical change for four hours if contractions are adequate and water has broken or for six hours if contractions are inadequate and water hasn’t broken.²

What Causes Stalled Labor?

Stalled labor has many possible causes, from emotional state to physical issues and more. Below are some common causes of prolonged labor:

Stress

Your body may release stress hormones in a state of anxiety or fear. These hormones, such as cortisol and catecholamines, can sometimes cause labor to pause. The purpose of these hormones is to protect a mother and her baby from delivery in an unsafe situation. Laboring in a calm, comfortable environment with a supportive birth team can minimize stress and decrease the chances of stalled labor.³ A comfortable environment may also make the mother feel free to get into any position that feels right for her.

Positioning

The optimal position for a baby during labor is with its head down and baby’s spine toward mom’s belly, facing your back. This is called an anterior baby. Anterior positioning allows baby’s head to press on the cervix, encouraging it to dilate. Malposition of the fetus is one of the main reasons for the cervix not dilating despite experiencing contractions. When baby is head down but facing your belly instead of your back (such as in a posterior or “sunny-side up” position), it may be more difficult for their head to engage and descend through the pelvis properly. This may cause contractions to start and stop. Or it can cause contractions to persist but labor not to progress because the contractions are ineffective, essentially pushing in the wrong place and not encouraging dilation.^3,4,5,12

Many babies will spontaneously rotate to the occiput anterior position on their own. However, there are ways to help spin a baby to face the right way, including positions that let your belly hang while you lean forward and manual rotation of the head by your doctor.^2,4,12

Birth Interventions

Pain management interventions, such as an epidural, can make moving and repositioning yourself difficult for the mother.³ This was my least favorite part of my epidural birth! My legs were numb and tingly and felt like dead weight. I couldn’t roll over or change my position without a lot of assistance from my nurse, husband, and positioning aids.

Perhaps because of limited maternal movement, epidurals can sometimes lengthen labor or cause it to stall. However, several recent studies have shown that the early administration of an epidural doesn’t affect the overall duration of labor.¹ Maternal movement, frequent repositioning, and being in an upright position can help labor progress. So, even if you do have an epidural, don’t be shy about asking for help with changing positions.^2,3,5

Risks of Prolonged Labor

In addition to being frustrating and mentally/physically draining, prolonged labor carries some risks to the mother and baby:

• Fetal hypoxemia: Prolonged labor can increase the risk of low blood oxygen levels in your baby.^1,6
  
• Operative delivery: Prolonged labor, particularly a prolonged pushing phase, can increase the likelihood of needing an operative delivery with forceps or a vacuum.^1,2
  
• Perineal trauma: Women with prolonged labor and a longer pushing phase are more likely to suffer from third- and fourth-degree tearing.²
  
• Postpartum hemorrhage: Stalled and prolonged labor may increase your risk of losing too much blood after delivery.²
  
• Infection: The longer a mother is in labor, the more she becomes susceptible to a uterine infection called chorioamnionitis, particularly if her water has broken or she has many cervical examinations.²

What Can You Do if Labor Stalls?

To avoid the risks of labor dystocia, you may want to know how you can get things moving again. If labor stalls, not all hope is lost! If you’re wondering how to kickstart labor back up, you may try these interventions and activities to avoid the risks of stalled labor:

Rest

Fatigue can contribute to prolonged labor. Despite being tired and wanting labor to be over, your body may be screaming for a small break. Maternal rest during labor can actually speed up cervical dilation. If you’re unable to rest due to the pain of contractions, some providers prescribe a small dose of morphine to enable you to sleep for a bit. You may wake up feeling refreshed, recommitted, and maybe even more dilated!¹ While an epidural does sometimes slow down labor due to constricted movement, it can also speed up labor by allowing your body to rest and relieving some of your pain and pain-related anxiety.¹

Move

While rest certainly has its place during prolonged labor, so does movement. Studies have shown that walking around and changing positions during labor can speed up the process. If your labor stalls, movement can help jumpstart contractions again. It can also increase the strength of your uterine contractions and help reposition your baby and pelvic bones to optimize fit through your birth canal.⁷

Water Therapy

Studies have shown that hydrotherapy provides effective pain relief, and a warm bath is a way to help labor progress. Soaking in a hot tub may quicken cervical dilation and jumpstart labor after it stalls. This may be because of its relaxing effects^1,8

Hypnosis

Hypnosis is a way to eliminate external distractions and concentrate on relaxation and the task at hand. While hypnosis hasn’t been clinically studied specifically for its effect on jumpstarting labor after it stalls, some believe it can help cervical dilation progress.¹ Hypnosis can relieve pain and decrease anxiety about labor and delivery, which may also indirectly speed up labor.⁹

How Long Can Labor Last?

Sometimes, all a stalled labor needs is a little more time and some of the efforts above to get things going again. While it can feel impossible to simply wait and ride out a long labor, it’s important to remember how long labor can last. Because the start of labor is somewhat ambiguous — going off contraction intensity and frequency — the length of labor, and especially the early stages, is an estimate.¹

First-time moms may experience longer labor than mothers who have given birth before. It can take up to 20 hours to dilate to 6 cm and another 8.6 hours to dilate from 6 to 10 cm. It can then take another three to four hours to push the baby out.² This adds up to nearly 33 hours total from the onset of regular contractions to delivery! (My first labor was around 30 hours.)

Many times, second and subsequent babies come more quickly. (My second baby came in about 90 minutes!) But even second babies can take their time. Mothers who have given birth before can still take up to 14 hours to dilate to 6 cm, another seven and a half hours to dilate to 10 cm, and two to three hours of pushing, totaling nearly 25 hours.²

How Is Stalled Labor Treated?

Time alone isn’t always an indication for treatments. As long as your cervix continues to dilate, prolonged labor may not require any intervention.² However, if you have preeclampsia, your water has broken but you aren’t having contractions, or you have an infection, stalled labor can become a risk to you or your baby.¹

If labor has stalled and you or baby are at risk, you and your doctor may decide to treat prolonged labor. There are two main ways they might consider, depending on your preference, how dilated and effaced you are, and what might be most effective:¹

1. Pitocin

Synthetic oxytocin (Pitocin) can sometimes be used as an induction tool or to augment a stalled active phase of labor. Pitocin can decrease the time to delivery. Pitocin dosing starts low and increases slowly to ensure your uterus tolerates and responds well to the stimulation.²

During my own stalled labor, after 12 hours of contractions with little cervical progress, I eventually got an epidural and started Pitocin. From the start of Pitocin until delivery, it was another 16 hours or so.

2. Amniotomy

For stalled labor, your provider may also sometimes recommend artificially breaking your water. On its own, breaking your water may not make much difference in progressing labor. But when combined with oxytocin augmentation, it can hasten the active phase of labor. Amniotomy does carry an infection risk.^1,2 It also puts you at risk for a rare complication of a prolapsed cord. This is where the cord comes through the vagina before the baby and can cut off their supply of oxygen and cause contractions to be more painful, as the cushion of the amniotic fluid is no longer present.¹¹

For these reasons, I personally elected to decline an amniotomy during my labor augmentation (despite countless nudges from my provider) and wait for my water to break on its own.

A stalled labor can be worrisome and frustrating. Once things have gotten going, you likely don’t want to wait any longer to meet your baby! Though there are risks associated with stalled labor, fortunately, contractions will likely pick back up again, and your labor will eventually progress, with or without medical intervention. Knowing about this condition and your options can help you remain calm and make informed decisions if a stalled labor happens to you.

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