Whether you are pregnant for the first time or have given birth before, labour and delivery can be a daunting prospect. It is often painful and uncomfortable, and can also be a bit scary. While most childbirths proceed normally, in some cases, labour does not progress. This is known as prolonged labour.
Prolonged labour occurs when the process lasts for far longer than typical, either due to the cervix not dilating or the baby not moving down the birth canal. This carries risks for both the mother and baby. In particular, babies are at an increased likelihood of complications such as infection, fetal distress, birth asphyxia, and shoulder dystocia. Oxygen deprivation during a prolonged labour is associated with serious birth injuries such as HIE and cerebral palsy. If a mother is experiencing failure to progress, the medical team should carefully monitor both her and the fetus and intervene when necessary.
The Birth Injury Lawyers Alliance (BILA) is a collective of skilled lawyers throughout Canada who advocate for the rights of families who have been affected by medical negligence. If your baby has been diagnosed with a birth injury after a prolonged labour, you may have cause to file a lawsuit for medical negligence. Reach out to BILA today to schedule a free consultation with a birth injury lawyer in your province.
What Is Prolonged Labour?
When a pregnant woman goes into labour, the way it proceeds can vary from person to person. When labour progresses slowly, it is known as prolonged labour or failure to progress. Prolonged labour occurs when a person is in labour for hours without moving on to the next stage.
There are three stages of labour:
- Stage 1 (early and active labour): During early labour, the cervix opens, softens, and gets shorter and thinner. Contractions are mild and inconsistent. It can last from hours to days. In active labour, the cervix dilates from 6 cm to 10 cm. Contractions are more consistent, stronger, and closer together in duration. Active labour can last from 4 to 8 hours or longer.
- Stage 2 (birth): In the second stage, the baby is delivered. This stage can last from a few minutes to a few hours.
- Stage 3 (delivery of the placenta): During the final stage of labour, the mother will deliver the placenta. There will be milder contractions as your body moves the placenta into the birth canal. The placenta is usually delivered within 30 minutes of giving birth.
Prolonged labour occurs during the first and second stages of labour. Typically, labor lasts from 12 to 24 hours for a first birth and 8 to 10 hours for subsequent births. Labour is considered prolonged when it lasts:
- 25 hours or longer for first-time mothers.
- 20 hours or more for mothers who have previously given birth.
Failure to progress happens in two situations. First, it may occur when the cervix starts to dilate, but stops before it reaches full dilation (10 centimeters). Second, it can happen when the cervix is fully dilated, but the baby stops moving down the birth canal.
During the first stage of labour, failure to progress is usually caused when the cervix thins (effacement) slowly. This is usually due to weaker uterine contractions. In some cases, medications used during labour can weaken contractions, which slows the birthing process.
During the second stage of labour, failure to progress can happen for a few different reasons. It may occur because the baby is too large or the birth canal is too small. It may also occur because the mother’s pelvis is too small for the baby to move down, or because uterine contractions are not strong enough to move the baby down the birth canal.
Prolonged labour is more common in certain situations. This includes multiple births, older maternal age, and having a higher body mass index (BMI). When a baby is lying in certain positions, it can also increase the likelihood of prolonged labour.
Failure to progress is not common. However, it is a frequent reason for cesarean section (C-section) births. That is because failure to progress can lead to complications, particularly during the second stage of labour. For this reason, it may become necessary for a doctor to intervene and perform an emergency C-section to protect both the mother and baby. Failure to do so may be considered medical negligence.
How Is Prolonged Labour Treated?
During the first stage of labour, there are things that you can do to help dilate your cervix and move labour along. Your doctor may suggest some home remedies, such as nipple massage, which can help your body produce more oxytocin to encourage stronger contractions. Alternatively, a warm bath may help you relax.
Medical interventions can also help to dilate the cervix. This may include an amniotomy, or artificial rupture of the membrane (also known as breaking the water). A doctor may also prescribe oxytocin (pitocin) to help ripen the cervix.
During the second stage of labour, an expectant mother may be advised to change positions or take a walk to help labour along. They may also be asked to try to rest and relax. Doctors may also start medication, such as oxytocin, to help labour progress.
The medical team should carefully monitor the progression of labour to ensure the safety of both the mother and baby. When necessary, an obstetrician should intervene to ensure that the baby is safely delivered and to reduce the risk of further complications. This may include:
- If the baby is not yet in the birth canal, medications such as oxytocin can be used to strengthen contractions.
- If the baby is in the birth canal, a doctor can use instruments, such as forceps or a vacuum extractor, to help pull the baby out.
- If delivery still does not progress and/or the mother’s or baby’s health is in danger, then an emergency C-section may be required.
Doctors must carefully monitor both the mother and baby so that they can intervene if necessary to protect their health. As described below, prolonged labour can be dangerous, so prompt intervention may be required to avoid complications.
Risks of Prolonged Labour
During the first stage of labour, failure to progress may not necessarily cause complications. While it can be mentally and physically exhausting for the labouring woman, it isn’t necessarily dangerous. During the second stage of labour, however, prolonged labour can increase the mother’s risk of:
- Postpartum hemorrhage
- Infection
- Future incontinence
- Future pelvic organ prolapse
- Uterine rupture
As noted above, prolonged labour also increases the likelihood that a mother will need an emergency C-section. Alternatively, an obstetrician may use instruments, such as a vacuum or forceps, to help deliver the baby. This can create a risk of trauma to the baby from forceps and vacuum.
In addition, prolonged labour can affect a baby in other ways. This may include:
- Infection (which can be passed from mother to baby)
- Fetal distress (a drop in fetal heart rate)
- Oxygen deprivation (birth asphyxia)
- Shoulder dystocia (getting stuck in the birth canal).
Oxygen deprivation during labour and delivery is associated with a number of conditions. When a baby does not get enough oxygen, it can cause brain damage. Hypoxic ischemic encephalopathy (HIE) is a type of brain injury that is caused by decreased blood flow to the brain.
HIE is associated with several different disabilities, including cerebral palsy, seizure disorders (epilepsy), behavioral issues, developmental delays, learning disabilities, and visual impairment. In the most serious cases involving a longer period of oxygen deprivation, birth asphyxia can be fatal.
The use of forceps or a vacuum extractor can also cause brain damage. If these instruments are not used properly or are used with excessive force, then the baby may suffer injuries such as brain bleeds (intracranial hemorrhage), kernicterus (severe jaundice), stroke, or skull fractures. This type of brain damage can cause a host of complications, including conditions such as brain damage.
The use of synthetic oxytocin (pitocin) to start or increase contractions can also be harmful during prolonged labour. Specifically, it can result in uterine hyperstimulation (tachysystole), which causes the mother’s contractions to become too strong, too frequent, and/or too long. This can deprive the baby of oxygen, increasing the risk of birth injuries such as HIE, cerebral palsy, fetal distress, neonatal seizures, jaundice, and retinal hemorrhages.
Prolonged labour can carry many risks to both mother and baby on its own. Part of these dangers comes from the treatments that the labour and delivery team may use to help labour progress, such as the use of medications to move labour along or the use of instruments to aid in delivery. If not administered or performed properly, these treatments can cause many complications.
This is particularly true for babies, who may suffer lifelong disabilities due to medical negligence. If your baby has been diagnosed with HIE, cerebral palsy, or another birth injury after failure to progress during labour, you may have a potential legal claim against the medical staff and/or hospital.
Reach Out to BILA Today
Prolonged labour is not necessarily common, but if it happens to you, it can be painful, exhausting, and scary. It may also cause injury to both you and your baby. If your treating physician or other medical professionals do not meet the standard of care for failure to progress, they may be held liable for any injuries that result, such as HIE, cerebral palsy, or shoulder dystocia.
If your baby was diagnosed with a birth injury after a difficult, prolonged labour, you may be able to pursue legal action against your doctor and the medical team. A birth injury lawyer will listen to your story and advise you of your legal rights and 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.
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The Birth Injury Lawyers’ Alliance of Canada (BILA) was formed in 2016 by a group of lawyers from across Canada with considerable experience in birth injury cases to promote the effective representation of children and families affected by avoidable injuries occurring at or around the time of birth.
