Being pregnant can be both exciting and a bit scary. When you go into labour, you will more than likely be ready to meet your new baby, but you may also be apprehensive about the process. In most cases, labour and delivery progress normally. However, approximately 8% of all births will involve what is known as prolonged labour.
Prolonged labour – which may also be referred to as failure to progress – is labour that lasts much longer than expected (generally, 20 hours or more). It can cause a range of complications for both the mother and baby, including infection, fetal distress, perinatal asphyxia (oxygen deprivation), and shoulder dystocia. Prompt intervention through an emergency cesarean delivery or the use of forceps or a vacuum can reduce the likelihood of complications associated with failure to progress.
At BILA, we understand that parents and families are often devastated and overwhelmed after their baby is diagnosed with a birth injury. If you believe that your child’s birth injury was caused by medical negligence, we can help. Reach out today to schedule a free consultation with a birth injury lawyer in your province.
What Is Prolonged Labour?
In a typical birth, the labour and delivery process may take 12 to 24 hours for a first baby and 8 to 10 hours for a subsequent birth. In some cases, however, labour fails to progress. Generally, labour is considered prolonged when it lasts for:
- 25 or more hours for a first baby; or
- 20 hours or more for a subsequent birth.
There are 3 stages of labour. During the first phase, uterine contractions begin and the cervix dilates from 0 to 10 centimeters (cm). In the second stage, uterine contractions continue, along with efforts by the mother to bear down and deliver the baby. During the third and final stage of labour, the baby is delivered. Labour ends when the placenta is delivered.
Prolonged labour occurs during the first or second stages of labour. A pregnant person may be in an active phase of labour for many hours without moving or progressing to the next stage. During prolonged labour, one of two things typically happens:
- The cervix starts to dilate but stops before full dilation at 10 centimeters; or
- The cervix fully dilates, but the baby stops moving down the birth canal.
During the first stage of labour, the mother’s cervix thins. This is known as effacement. Slow effacement, or arrested dilation, can increase the amount of time that a mother spends in labour. It is usually caused by insufficient uterine contractions, which may be linked to certain medicines that are used during labour.
In the second stage, labour is considered prolonged if it lasts more than 3 to 4 hours for a first birth or 2 to 3 hours for a second or subsequent birth. In this stage, failure to progress occurs when the baby is not moving down the birth canal. This can happen for a variety of reasons, including a baby that is large for its gestational age, a small birth canal or pelvis, or weak uterine contractions.
The main sign of prolonged labour is that you are in labour for an extended period of time, typically over 20 hours. Because failure to progress can cause complications for both the mother and fetus, prompt medical intervention is critical.
During the first stage of labour, a physician may recommend breaking your water (amniotomy) or a medication like oxytocin (Pitocin) to help “ripen” the cervix. When prolonged labour occurs during the second stage of active labour, vaginal delivery may no longer be possible. An emergency c-section may be necessary, or the use of tools like a vacuum or forceps to aid in a vaginal delivery.
What Are the Possible Complications of Prolonged Labour?
Failure to progress during the first stage of labour rarely causes serious complications. However, it can be both physically and mentally exhausting for the mother to labour for many hours without moving forward.
During the second stage of labour, the potential complications of failure to progress are far more serious. For the parent, there is an increased risk of infection, future incontinence, postpartum hemorrhage (which may require a hysterectomy), uterine rupture, and future pelvic organ prolapse. Failure to progress at any stage of labour can increase the likelihood of a similar issue in any future pregnancies.
Prolonged labour during the second stage of labour is associated with birth injuries to the baby. This may include:
- Infection typically passed from the parent to the baby
- Fetal distress
- Oxygen deprivation, or perinatal asphyxia
- Shoulder dystocia, or getting stuck in the birth canal.
In particular, failure to progress is associated with hypoxic ischemic encephalopathy (HIE), a brain injury caused by insufficient oxygen and decreased blood flow in the brain. HIE can cause a number of serious, lifelong disabilities, including cerebral palsy, developmental delays, seizure disorders such as epilepsy, behavioral issues, learning disabilities, and visual impairment. In some cases, birth asphyxia can lead to death.
The potential for serious complications from prolonged labour makes it all the more important that physicians closely monitor both the progression of labour AND the baby for any signs of fetal distress. If a doctor, nurse, or another member of the team observes fetal distress, they should quickly intervene to deliver the baby. In addition, mothers who are at higher risk for prolonged labour should be closely monitored throughout pregnancy.
If a baby is born after prolonged labour, the healthcare team should immediately assess them using the Apgar Test. If the baby shows any signs of oxygen deprivation or HIE, then cooling therapy should be started immediately. While hypothermic therapy (or therapeutic hypothermia) cannot reverse brain damage caused by lack of oxygen, it can reduce the risk of or prevent further brain damage. If a doctor fails to implement this or other treatments, it may be a sign of medical negligence.
Are There Risk Factors for Failure to Progress?
There are certain factors that can increase the likelihood that you will experience prolonged labour. These include:
- Starting labour with medications such as oxytocin or Pitocin
- The use of an epidural
- Premature rupture of membranes, which occurs when the mother’s water (amniotic fluid sac) breaks before labour starts
- Problems with the fluid sac around the fetus
- Prior failure to progress in a previous childbirth
- Carrying multiples
- The baby lying in certain positions (such as breech position)
- Older maternal age
- High body mass index (BMI)
- Fertility treatments
- A large baby for gestational age
If you have any of these risk factors, you should talk to your doctor about how to reduce the risk of prolonged labour. Your healthcare team should also be aware of the increased likelihood of failure to progress, and be ready to intervene as necessary to protect your health and the health of the baby. Medical care for prolonged labour can include the administration of medication, the use of operative deliveries, and the use of tools to aid in vaginal deliveries.
Help for Parents and Families
Medical professionals must meet a certain standard of care when providing treatment, including caring for mothers and infants throughout pregnancy, labour, and delivery. If a doctor or another member of the labour and delivery team fails to meet this standard, then both the mother and baby may suffer serious birth injuries. In particular, failure to properly monitor labour and intervene if there are signs of prolonged labour or fetal distress may cause HIE, cerebral palsy, and other birth injuries.
If you believe that your baby may have suffered a preventable birth injury due to complications associated with prolonged labour, a birth injury lawyer can advise you of your legal options. For help with HIE cases or other types of birth injury claims, call BILA today at 1-800-300-BILA or fill out our online contact form to schedule a free initial consultation with a lawyer in your province.
How Do I Know If I Am in Prolonged Labour?
The main sign of failure to progress is that labour is taking an excessively long time – generally, over 20 hours. Your obstetrician can check your cervix for effacement and dilation during the first stage. If it hasn’t dilated to 10 centimeters, they may need to intervene to help you move to the next stage. During the second stage, if your baby is not moving down the birth canal, then you are in prolonged labour.
Failure to progress can cause serious complications for both the parent and the fetus. It may be necessary to have an emergency c-section if you are in labour for more than 20 hours without delivering. If your baby is diagnosed with a birth injury after prolonged labour, reach out to BILA to talk to a birth injury lawyer in your province.
Will Getting an Epidural Cause Failure to Progress?
It is unclear whether epidurals caused prolonged labour. In some cases, it may help the mother to relax, which may reduce the likelihood of prolonged labour. However, certain medications – including painkillers – are associated with failure to progress. If you got an epidural or other medication during labour, then it may have contributed to a failure to progress.
Birth injury cases can be complicated, particularly when there is conflicting evidence about how certain treatments may affect a pregnant person and fetus. If your baby has been diagnosed with a birth injury or you suffered an injury while giving birth, we can help. Contact BILA today to talk to a birth injury lawyer in your province.
How Does Prolonged Labour Cause Birth Injuries to Babies?
Prolonged labour can lead to oxygen deprivation, or birth asphyxia, in babies. Essentially, the baby’s brain is deprived of oxygen and adequate blood supply, which starts a cycle of injury that can cause permanent brain damage. Mild birth asphyxia may cause minimal lasting effects. However, in severe cases, birth asphyxia can cause permanent brain damage, conditions like cerebral palsy, and even death.
The potential for these devastating consequences makes it all the more important that a physician properly monitor both mother and baby during pregnancy and throughout the labour and delivery process. A failure to do so – or to promptly intervene – may be a sign of medical negligence. Call BILA to talk to a birth injury lawyer in your province about a potential claim.
John McKiggan, QC has represented clients in pediatric and adult injury claims that have resulted in multi-million dollar awards. In recognition of his accomplishments, John has been honoured by his peers, who elected him president of the Atlantic Provinces Trial Lawyers Association. He has also been named Queen’s Counsel, a designation recognizing exceptional professional merit. John has been selected for inclusion in the Best Lawyers in Canada in the field of personal injury law, he is listed in the Canadian Legal Lexpert Directory and has been named a local litigation star by Benchmark Litigation Canada.