Prolonged labour
Labour is said to be prolonged when contractions fail to bring about the expected progress. This may be because the cervix hasn't dilated, or the baby hasn't descended through the birth canal.
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Doctors and midwives keep a very careful eye on the length of each stage of labour. If labour appears to be going more slowly than normal, your attendants may suspect delay and take an early decision to intervene - with an assisted delivery if it's suitable, or even a Caesarean section.
No woman is allowed to go on with a difficult birth for much over the accepted times as this may lead to maternal exhaustion and/or fetal distress. Your midwife will be monitoring your general condition throughout labour, and she'll be alerted to possible delay if your condition appears to get worse and you look tired and anxious.
If your labour is very long and you're going without food and rest, you might become too tired or upset to push enough. Your midwife will try not to let this happen.
Failure to dilate during prolonged labour
When contractions are weak and infrequent and your cervix is dilating slowly, the uterus may be failing to coordinate muscular activity. If this is the only reason for the lack of progress in your labour, your attendants may suggest speeding up dilatation. The membranes may be artificially ruptured and then a drug called syntocinon may be administered intravenously with a drip or with a pump. The dosage will be carefully increased until strong contractions are coming regularly about every three minutes.
Your midwife and doctor will keep a close check on you throughout to make sure there are no excessive increases in the strength or frequency of your contractions.
Failure to descend during prolonged labour
I've mentioned breech and posterior presentation as causes of delay. One other reason for a slow labour is disproportion. This means that the size of your baby's head and the size of your pelvis are failing to match up - for example, if your pelvis is too small relative to your baby's head. It's easy to understand how your baby might fail to descend in such circumstances.
If you're a first-time mother and your baby is still high and not engaged during the last few weeks of your pregnancy, your doctor may suspect disproportion. This will also be taken into account if your baby's head remains high during labour even though you're having strong contractions.
If the disproportion is quite slight, your doctor may let you try to have a trial of labour (bear in mind that it's your uterus on trial, not you), provided there are no other irregularities, and the baby's head is felt to be descending. Once the baby's head has entered the pelvic cavity, there can usually be a vaginal delivery. If the disproportion is major, your baby will need to be delivered by Caesarean section.
Don't worry - most of the abnormalities that cause obstruction and a prolonged labour (see Causes of fetal delay) will be picked up during your pregnancy so that early treatment is possible, and a plan of action can be made by the doctors and midwives before your labour begins.
Causes of fetal delay
- your baby is too large
- your baby is lying in a transverse or oblique position
- your baby is in a breech, face, or brow presentation
- your baby is lying in the posterior position
- your twin babies are entwined
- your baby has a congenital abnormality such as hydrocephalus
- your pelvis is particularly small or an unusual shape.
Maternal causes of delayed labour
- deformity or disproportion of the bony pelvis
- pelvic tumours such as fibroids or an ovarian cyst
- abnormalities of the uterus, cervix, or vagina
- a contraction ring of the uterus, which is when the uterus pulls in excessively and a band of tight muscle occurs. This can stop contractions passing all the way down and may cause constriction of the uterus or cervix. Fortunately, this condition is very rare, unless the uterus has been overstimulated by oxytocin or prostaglandin, for example, during induction. A Caesarean section is almost always needed.
Posted 16.11.2010
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