Questions?
As a mother plans for her delivery, it is common to think, “I hope this pain doesn’t last forever and my labor is quick!” Sometimes mothers hope labor and delivery are not too quick if they are looking for some pain relief and time for an epidural.
But what happens if your labor lasts too long? It may not even cross your mind that, after your labor starts, it may stall or stop progressing.
For women who experience this, it can be extremely frustrating. There are many fears and questions about why this is happening and what could be causing it. Beyond that, the real worry is this: How long can I be in labor before it is harmful?
As a nurse, I want to help you understand what prolonged labor is, why it can happen, the risks to your child, and what steps can be taken to prevent harm.
What Is Prolonged Labor?
To understand prolonged labor, it’s helpful to start with a few common terms used in labor and delivery. Labor is typically divided into stages based on how far the cervix has dilated and how the baby moves through the birth canal.
Prolonged labor can increase the risk of complications for both the mother and baby, making monitoring and intervention critical. Understanding the stages of labor and what can cause delays can help families recognize when something may be going wrong.
The stages of labor include:
- Early phase of labor: The cervix (the lowest part of the uterus) is softening and dilating (opening) up to 6 cm
- Active phase of labor: The time after the mother’s cervix is dilated to 6 cm
- First stage of labor: When the cervix is softening and dilating, the uterus is contracting, and the body is lowering the baby to prepare for birth
- Second stage of labor: Pushing and delivering the baby after the cervix is 10 cm (complete)
- Prolonged first stage of labor: When a mother has been in labor for over 20 hours for a first baby or over 14 hours if she has given birth previously (also known as prolonged latent phase of labor)
- Prolonged second stage of labor: More than 3 hours of pushing for first-time mothers or 2 hours for mothers who have previously given birth
- Failure to progress: Another term for prolonged labor; a diagnosis given when a mother’s cervix stops dilating or the baby is not descending lower to prepare for birth, often despite interventions
- Arrest of labor: A stop or pause in the progress of labor, either in the cervix no longer increasing in dilation or the baby has stopped lowering to prepare for birth
The early phase of labor can stop and start back up again. Most women experience the start of early labor at home, and it can last a few hours or a few days. Early labor often becomes faster with each pregnancy.
When the contractions begin to become stronger and closer together, the mother comes to the hospital to check the progression and, if she is making cervical changes, will be admitted to prepare for birth.
Is Prolonged Labor Dangerous?
A prolonged early stage of labor is not necessarily dangerous, unless there are other health concerns for the mother or baby. This includes conditions like infection, fetal distress, or complications that limit the baby’s oxygen supply.
If a mother is brought to the hospital for induction of labor, which is receiving medications to try to start labor, this can sometimes take days as the cervix softens and should not be considered prolonged labor.
Once a mother reaches active labor and there is a pause in progression, it can be dangerous for both the mother and the baby.
Prolonged labor signs and symptoms include:
- Cervix is over 6 cm dilated
- Water has broken (a rupture of the amniotic sac that surrounds the baby in pregnancy)
- There have been at least 4 hours of true contractions or 6 hours of using medications to have the uterus produce effective contractions
According to the American College of Gynecology (ACOG), the doctor should be concerned about the stopping of dilation or lowering of the baby and diagnose a mother with arrest of active labor under these conditions.
What Causes Prolonged Labor?
There are a few different situations that can cause or increase the chances of prolonged labor. Being over the age of 35, having a first pregnancy, obesity, and carrying multiple babies can all increase a person’s risk of prolonged labor.
If a mother’s labor has stalled, the doctor should also be concerned about these possibilities:
- The baby is too large
- The mother’s pelvis is too small
- The contractions are too weak
- The baby is “sunny side up,” or lying in occiput posterior position (baby’s head is facing forward to the mother’s abdomen)
When health care providers fail to take these factors into consideration and an infant suffers a birth injury as a result, it may be considered medical malpractice.
Prolonged Labor Effects on Baby
If a mother has been in the first stage of labor for over 20 hours for the first baby (or over 14 hours if she has given birth previously) or if labor has come to a stop, there are risks of harm for the baby.
Potentially harmful prolonged labor effects on a baby include:
- Lack of oxygen (hypoxia)
- Infection (maternal chorioamnionitis, which can cause other infections in the baby)
- Increased distress or a drop in the baby’s heart rate
- Low APGAR scores after delivery, indicating poor infant status
Steps can be taken to progress a lengthy labor before it reaches a point of concern, such as starting medications that help increase the strength and frequency of contractions or breaking the mother’s water if the baby is low enough and if her water is still intact.
A device called an intrauterine pressure catheter (IUPC) can be placed by a doctor to help them see the strength of the contractions and if they may be too weak. However, if interventions are ineffective or the baby is showing signs of distress, a C-section may need to be performed.
Prolonged 2nd Stage of Labor Risks
If there is a prolonged second stage of labor (more than 3 hours of pushing for first-time mothers or 2 hours for mothers who have previously given birth), there are risks of harm.
Prolonged 2nd stage of labor risks include:
- Lack of oxygen to the baby
- Shoulder dystocia (head is delivered, but shoulders are stuck behind the mother’s pelvic bone, cutting off oxygen to the baby)
- Postpartum hemorrhage or excessive bleeding for the mother after birth
- Injury from assistive delivery tools, such as forceps or a vacuum, which are often used after prolonged pushing
- NICU admission due to infant distress
The American College of Gynecologists recommends that a C-section be performed if a mother’s labor stops in the active phase of labor.
ACOG also recommends that the doctor perform an operative vaginal delivery using assistive delivery tools to deliver the baby if she is pushing and the baby is not born within 3 hours for a first-time mother.
Prolonged Labor Complications
Prolonged labor has the potential to cause serious harm. Babies who experience a prolonged lack of oxygen — often associated with extended first or second stages of labor — may develop other conditions with lasting effects.
Prolonged labor complications include:
- Cerebral palsy: A group of disorders that affect muscle control and movement; these children often have seizures and learning, speech, and swallowing disabilities
- Hypoxic-ischemic encephalopathy (HIE): Brain damage from lack of blood and oxygen during delivery that can lead to developmental disabilities, learning disorders, and seizures
- Intraventricular hemorrhage: Bleeding in the cavities of the brain, which can lead to lasting brain damage complications
Doctors are responsible for closely monitoring your labor progression and performing interventions that keep you and your baby safe. As a nurse, it is difficult to see labor stall and hours go by without progression for a mother.
Overall, the biggest goal of caregivers is to ensure you and your baby are safe and healthy. If you feel like your medical team made poor decisions in your care, such as delaying a medically necessary C-section after your labor was prolonged, this is not okay, and you have a right to learn your options.
Get Help From Prolonged Labor Attorneys
If you believe a medical mistake caused your infant to be harmed, please reach out to our team today. You don’t have to navigate this alone.
Birth Injury Justice Center works with a team of experienced prolonged labor lawyers who can review what happened, explain your rights, and help you understand whether your child’s injury may have been preventable.
A legal claim can provide answers, accountability, and the financial support your family may need for therapies, equipment, and long-term care.
Call (800) 914-1562 right now for a free case review. We’re here to listen and to help you take the next steps toward securing your child’s future.
