A Guide to Prolonged, Difficult and Long-Term Labour
Labour can be a deeply personal and powerful experience. It is filled with emotion, anticipation, and, sometimes, even unexpected twists. Some births are smooth, but others can be more difficult or require medical intervention. This is called difficult and extended labour. It can be physically and mentally challenging.
Professor Hannah Dahlen is a professor of nursing and midwifery and a midwife at Western Sydney University. She stresses the importance of trusting your body’s natural abilities while being ready for any changes that may occur. She says that being flexible and well-informed gives parents a feeling of empowerment even when things do not go according to plan.
This guide will explore the meaning of difficult labour, what causes it, how you can recognize it, and what you can do before and during delivery to help you navigate it with confidence and strength.
What is Prolonged or Hard Labour?
The term difficult or extended labour is used to describe labour that takes longer than expected or does not progress as expected. The standard definition is:
- More than 20 hours for new mothers
- For women who have previously given birth, over 14 hours
The term difficult work can also refer to situations where:
- The baby doesn’t descend properly
- The cervix ceases to dilate
- The contractions are too weak or too strong
- When pain becomes unbearable or distressing
- Signs of maternal or fetal distress
What Causes Prolonged Labour?
Many factors can cause labour to not proceed smoothly. There are many reasons why labour might not progress smoothly.
1. Baby Position
“Sunny-side up” or lying sideways can slow down progress. The baby’s progress can be slowed if he is lying in the wrong direction (e.g., This is called misposition, or mispresentation.
2. Weak Uterine Contractions
Some contractions may not be strong enough or regular enough to move the baby through the birth canal or dilate the cervix.
3. Cervical Problems
It is possible that the cervix does not open or thin as it should. This can cause labour to be delayed significantly.
4. Pelvic structure
Cephalopelvic Disproportion (CPD) is a rare condition where the size or shape of the mother’s uterus can make it difficult for the baby to pass.
5. Anxiety and Stress
Fear or emotional stress during labour can affect the release of the hormone oxytocin that causes contractions.
6. Medical Conditions
Conditions such as gestational diabetes, preeclampsia, or infection may complicate labor and require intervention.
7. Large Baby (Macrosomia)
If a baby is larger than average, it may be difficult to pass through the birth canal. This can lead to a prolonged second stage of labour.
Signs that a Labour is not progressing
Early intervention is possible when you recognize the warning signs of a long or difficult labour. Here are some red flags:
- Slowing down or stopping contracts
- No change in cervical dilation over several hours
- The baby does not descend into the pelvis
- Extreme exhaustion of the pregnant person
- Heart rate increases in the mother or the child
- Pain levels that are not responding to coping methods
What Can You Do if You are Working for a Long Time?
Healthcare providers can suggest different interventions if labour does not progress. Here are some common options.
1. Positions
Changing position, such as standing up, kneeling, or leaning towards the baby, can help it rotate and descend.
2. Using or Walking with a Birthing Ball
Gravity and movement can help the baby to be in the best position.
3. Nutrition and Hydration
The fatigued worker can be less productive. Drinking fluids and eating light snacks (if permitted) can help maintain energy levels.
4. Breaking the Water (Amniotomy)
A provider can break the membranes if they haven’t yet ruptured to encourage stronger contractions.
5. Pitocin(Oxytocin drip)
Sometimes synthetic oxytocin can be used to regulate or strengthen contractions.
6. Epidural
It may be necessary to provide pain relief, particularly if the mother feels extremely tired or upset. An epidural may also relax the muscles and allow cervical dilation.
7. Assisted birth
Forceps or vacuum assist may be used if pushing is prolonged.
8. Caesarean Section
A C-section is the best option for mother and child if labour does not progress or fetal distress occurs.
Prepare for Labour
It is important to prepare for unexpected situations. Here are ten things you can prepare in advance.
1. Create a flexible birth plan
Be open to changes if needed, but include your preferences. If things change, a rigid plan may lead to disappointment.
2. Take a Comprehensive Class on Childbirth
Classes cover the stages of labour, coping techniques, and common complications.
3. Prepare a hospital bag for emergencies
Include comfort items such as a pillow, essential oils, and a long-lasting phone charger.
4. Talk to Your Provider about “What-ifs”
You don’t want to be caught unawares by situations like C-sections, induction, or assisted delivery.
5. Know Your Pain Relief Options
You can be informed about the natural and medical methods of pain relief during labor by researching.
6. Prepare Your Mind for Change
Remember that the ultimate goal of a healthy mother and baby is not to have a perfect plan.
7. Arrange Support People
Select someone who will advocate for you and provide comfort.
8. Learn about Labour Positions
Changing positions or standing up frequently can reduce the length of time it takes to complete a task and help you avoid discomfort.
9. Understanding the Signs of Labour Progression
When you know what is normal and what is not, it will help you to determine when to contact your provider.
10. Plan for Postpartum Support
You may be physically and mentally exhausted after a long or difficult work. Get help at home to recover.
5 Tips to Deal with Difficult Work
Five key strategies for managing labour when times get tough
1. Keep Calm and Focused
Fear and tension can cause labour to feel painful and even slow down. Stay grounded by using relaxation techniques, music, or visualization.
2. How to communicate with your care team
Ask questions to understand what’s happening. Ask questions to understand what is happening.
3. Don’t be afraid to change your plan
You haven’t failed if you choose an epidural or accept an intervention. Adaptability is a strength.
4. Use breathing and movement
Moving between contractions and breathing deeply can help manage pain and promote progression.
5. Lean On Your Support System
It can be a huge help to have someone who will support and reassure you in difficult times.
The Emotional Impact Of Difficult Work
It is not only physically exhausting, but also emotionally draining to endure a difficult or prolonged labour. If their birth did not go according to plan, some women may feel disappointed or grieve. Others may feel trauma or guilt. These emotions are valid.
Consider these options if you have experienced a difficult delivery:
- Talking with a birth trauma specialist or counsellor
- Joining a support group for postpartum recovery or birth recovery
- Write your birth story to process what has happened
It is important to heal emotionally as well as physically after a hard labour.
When to Seek Medical Care During Labor
It’s important to understand when you should seek medical attention, whether you plan to give birth at home or in a birthing center. If you experience:
- Contractions may slow down or stop for longer than one hour during active labor
- If you experience severe bleeding or pain
- The baby’s movements have changed suddenly
- You may have a high fever or chills
- If your water is brown or green (indicating meconium), it could be a sign that you are leaking.
Stay Informed
It can be a daunting experience to go through a difficult or long labour. But many people who give birth have experienced it and overcome it with courage and strength. Remember to trust your body and prepare your mind. There is no “right” way of giving birth. No matter how you get there, a healthy baby and mother are the ultimate goal.
