What causes delay of labour?

Prolonged labor and cerebral palsy often occur together because of the complications that arise. Labor that lasts for 18 to 24 hours or more increases the risk of cerebral palsy developing in the baby. It is a significant risk factor for this condition.

What Is Prolonged Labor?

Prolonged labor is also referred to as “failure to progress.” It refers to labor that goes on for about 18 to 24 hours after regular contractions begin. For twins, labor that goes on for 16 hours is considered prolonged.

Mothers having their first baby are expected to be in labor for a longer period of time, so prolonged labor may not be declared until 22 to 24 hours. In contrast, for second or third-time mothers, labor may be considered prolonged after 16 to 18 hours.

What Causes Prolonged Labor?

There are many potential causes of prolonged labor. A very large baby may cause labor to take longer because it cannot move through the birth canal. A breech position—with the baby’s feet or bottom positioned to emerge first—may also cause prolonged labor.[1]

Other possible causes are an abnormally small pelvis or birth canal in the mother, weak uterine contractions, a slow-effacing cervix, or even severe anxiety or stress in the mother.

Treating Prolonged Labor

If labor is taking an unusually long time, a woman’s doctor or nurses will monitor her carefully for the timing of contractions and their strength. They will also monitor the fetal heart rate and the mother’s vital signs.

If the prolonged labor continues, contractions seem too weak, or the health of the mother or baby is at risk, doctors may take steps to speed delivery:

• If the baby is already in the birth canal but delivery is still taking a long time, a doctor may use instruments like forceps or a vacuum extractor to help pull the baby out.
• If the baby has not progressed that far, the mother may need to take a medication called Pitocin to speed up and strengthen contractions.
• This can help delivery progress better, but if it does not help enough or if the risks to the mother or baby’s health are deemed significant, the doctor may perform a Cesarean section.

Prolonged Labor Puts Women and Babies at Risk

A study of over 120,000 women found that prolonged labor during the second stage—after the cervix has dilated to ten centimeters—posed serious risks for the mother and her baby.

The mothers experiencing prolonged labor were more likely to have postpartum hemorrhaging, obstetric trauma, infections, or a combination of health problems.

Babies born after a prolonged second stage of labor were found to be at a greater risk for a combination of health issues, for being admitted to the neonatal intensive care unit, and for having a low score on the 5-minute Apgar test.

The Apgar test is evaluated at one minute and five minutes after birth to determine how well the baby is faring. It looks at things like heart rate, muscle tone, reflexes, breathing, and skin color.

Low scores are associated with difficulty breathing, a low or absent heart rate, low muscle tone, poor or no reflexes, and blue skin color. A low score has also been associated with later diagnoses of cerebral palsy.

How Prolonged Labor Can Lead to Cerebral Palsy

Results from studies are clear: prolonged labor puts children at risk for developing cerebral palsy. Exactly why this is true is not completely understood or may not be known in every case, but there are several likely possibilities.

If labor is prolonged but the baby is already in the birth canal, the doctor may use instruments to pull the baby out. The use of forceps or a vacuum extractor can cause damage to a baby’s skull, literally by crushing it with too much force. This can easily lead to brain damage that causes cerebral palsy.[2]

Another cause of brain damage leading to cerebral palsy is oxygen deprivation to the fetus or newborn, known as birth asphyxia. The longer the baby is deprived of oxygen, the more severe the damage may be.

Things that can cause birth asphyxia are also associated with prolonged labor:

• Hemorrhaging
• A large baby that gets stuck on the mother’s pelvis
• Complications with the umbilical cord
• Shock in the mother
• Tearing of the placenta from the uterus
• Abnormal presentation of the baby as it emerges from the uterus and birth canal

Prolonged labor is a problem that many women face when giving birth. It can cause a number of problems, but with the proper care from doctors and nurses, there do not have to be any lasting complications.

Early diagnosis and treatment for prolonged labor are crucial for the best outcomes. Many cases of cerebral palsy could have been avoided with better medical care.[3]

If you had prolonged labor and your child was diagnosed with cerebral palsy, you may be able to file a lawsuit to prove that your medical care was inadequate and seek the justice and compensation your child needs to live with this condition.

While there are certain universal markers for the different stages of labor, not all people experience labor in the same way or at the same pace. When a person is in active labor and the process slows down or stops, it is referred to as "stalled labor." Reasons for the stall can include a slowing down of contractions, contractions without dilation, or the baby not descending, despite contractions still occurring.

A stalled labor can feel distressing and discouraging, but the good news is that it usually does not pose any danger and can often be resolved. Here's everything you need to know about stalled labor, from what the term means to things you can do to help the process resume—and the problem resolve.

Stalled labor, sometimes referred to as prolonged labor, occurs when labor ceases, pauses, occurs to slowly, and/or fails to progress. According to the American Pregnancy Association, labor is concerned prolonged when it exceeds a certain length of time, i.e. prolonged labor is usually "diagnosed" when a pregnant person has been in active labor for 20 hours or more. However, labor can "stall" at any time. (I failed to progress at four centimeters with my first.)

Numerous factors can cause labor to stall, including—but not limited too:

• Baby's position. How your baby is positioned can affect the length of your labor. A baby is considered "malpositioned" for birth when they are not positioned facing your back or left side. Correcting the baby's position could mean an easier, quicker labor. If you or your care providers suspect that your baby's position is causing issues with your labor, walking and changing positions can help correct this.
• Emotional stress. Underlying emotional and/or psychological stress can cause labor to stall or slow down. Known as "emotional dystocia" this can be anything from an extreme fear of pain to trauma, unease, and/or not feeling safe.
• The size of the baby and/or of your birthing canal. If your baby is large or your birthing canal is small, labor may stall out because baby has no where to go. In these cases, a cesarean section will likely be suggested.
• Using an epidural . Some studies have shown that epidural use can slow down the pushing phase of labor, and while data is inconclusive of its effect on active labor and transition, many report that their contractions weaken and space out after receiving an epidural, often leading to the use of Pitocin to get it going again.

If you have any underlying issues you think could impact labor, notify your birth team (partner, doula, doctor, midwife, nurse). They will help you to deal with the emotions coming up during your labor, reassure you of your safety, and support you during the process.

If labor stalls, take heart in knowing that it's most likely temporary. In many cases, labor resumes on its own. There are things, however, that you can do to encourage labor, including:

1. Rest. If you can manage to rest—and if you are not being pressured to get labor going again—take advantage of the time. Labor is hard work, and any opportunity you can take to rest will help your body recharge.

2. Walk or change position. Walking and/or changing your position while in labor can work wonders for progression. Gravity and bodily movements can help baby descend and get into a more optimal position. Sometimes, a few good squats are all it takes to cross the threshold of a stalled labor. If you're lying down, get upright. If you're sitting on a birth ball, try standing, squatting, or walking around. If you're experiencing back labor, try stair walking or side lunges. And if you are laboring with an epidural, you can still use movement and position changes to help your labor progress. Rolling over, for example, can be helpful.

3. Consider nipple stimulation. Nipple stimulation (by way of rolling your nipples between your thumb and pointer finger or rubbing your nipples with your palm) is a very effective tool for bringing on longer and stronger contractions. Ask your doula or nurse to provide you with more information on this practice.

4. Change your environment. Sometimes, your environment (especially in the hospital) can cause a mental or emotional block that's stalling labor. Are the lights too harsh? Is the presence of your mother-in-law disturbing you? Are there too many nurses coming in and out? Environmental stimulus can impact the progress of labor. Dimming the lights, asking for some privacy, turning on music, and spraying lavender oil are just some of the ways you can change your environment and enter a more relaxed state.

5. Shower. It may take some convincing, but getting into a shower during labor can help you relax and may help intensify contractions. The water and heat release feel-good endorphins, and when you face the water, the stimulation on your nipples releases oxytocin, the hormone responsible for contractions.

If rest and the aforementioned suggestions do not work, your doctor may suggest some form of medical intervention. Pitocin may be administered, for example, and/or your "water" may be broken. A cesarean section may also be recommended.

That said, it's important to note that unless you and/or your baby are at-risk, you have a say in the matter. If your care provider recommends Pitocin, find out if it's medically necessary. You can ask: Is my baby healthy? Am I healthy? What are the risks in continuing to labor without Pitocin? If your care provider recommends a cesarean, repeat the same questioning. And, when in doubt, ask for more time. If your baby is not in distress, and you are comfortable, most healthcare providers will honor this request.

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