What is Prolonged Labor?
Normal labor consists of uterine contractions that result in progressive effacement and dilation, or thinning and stretching, of the mother’s cervix. Labor advances gradually through the latent phase and, once the dilating cervix reaches a width of over four centimeters, the more active, rapid stage of labor starts. During this phase, the mother’s cervix will dilate progressively at a rate of 1.2 centimeters per hour or more during her first pregnancy, or a rate of 1.5 centimeters per hour for subsequent pregnancies. If labor does not progress at this speed, the mother may be in prolonged or arrested labor.
Causes of Prolonged Labor
The prolongation of labor is usually caused by conditions that result in inadequate contractions or mechanical impediments. The most common complications that can cause prolonged labor are:
- Fetal malpresentation: Problems with labour progression can arise if the infant is not in the vertex position prior to birth.
- Cephalopelvic disproportion: Cephalopelvic disproportion takes place when there is a discrepancy between the size of the mother’s pelvis and the size of the fetus. This size disparity can result in the slowing or total stoppage of labor.
- Issues with uterine contractions: Insufficient uterine activity happens when the contractions are either not coordinated enough or not strong enough to dilate the mother’s cervix and push the newborn out. Problems with uterine activity can be caused by multiple gestations, excessive use of anesthesia or painkillers, and numerous other factors.
- Maternal obesity: A high maternal body mass index is associated with protracted first-stage labor, along with other assorted pregnancy complications.
Complications Associated With Prolonged Labor
If labor proceeds too slowly or stops altogether, dangers can arise for both the baby and the mother. In these cases, it is essential that healthcare professionals take immediate action in order to prevent serious long-term injuries. The dangers most often associated with mismanaging prolonged labor include:
Risks to the Fetus
Fetal risks associated with prolonged labor include:
- Oxygen deprivation leading to fetal distress
- Intracranial hemorrhage
- Increased chance of delivery using a vacuum extractor or forceps
- Sepsis
- Cerebral palsy
- Hypoxic-ischemic encephalopathy
- Seizure disorders
Risks to the Mother
Prolonged labor also poses several risks to the mother, such as:
- Intrauterine infections
- Trauma to the birth passage, such as tears to the vaginal walls and cervix
- Postpartum infection
- Postpartum hemorrhage
How is a Prolonged Labor Managed?
Fortunately, there are several methods that can be used to successfully manage prolonged labor and prevent birth injuries
Pitocin/Oxytocin
If the mother has a prolonged active stage of labor, doctors will sometimes give them Pitocin. Pitocin is a synthetic hormone that, when properly administered, can strengthen uterine contractions and induce labor, thereby allowing the labor process to progress at a normal rate. However, if administered incorrectly or in large doses, it can lead to excessive uterine contractions, endangering the infant’s oxygen supply and putting both the baby and the mother at risk.
Amniotomy
Amniotomy, or the forced rupture of the membranes, is a medical procedure whereby the doctor ruptures the mother’s membranes with a special tool to help speed up labor. Used in conjunction with Pitocin, amniotomy could help to augment or induce labor. Keep in mind, however, that there numerous are risks linked to both amniotomy and the use of Pitocin.
Vacuum Extractors and Forceps
Vacuum extractors and forceps are both tools used to aid in vaginal births. When used appropriately, they can quicken the delivery of the infant. Incorrect use, however, can lead to traumatic birth injuries, which could be permanent. Injuries linked to the improper use of these tools include:
- Hemorrhages
- Seizures
- Erb’s palsy
- Hypoxic-ischemic encephalopathy
- Cerebral palsy.
Due to these risks, vacuum extractors and forceps are not generally tools that are recommended for the management of prolonged labor.
C-section
In the event that a vaginal delivery will put the mother or baby at risk, a C-section can be performed. Conditions that indicate the baby should be delivered right away include umbilical cord prolapse, uterine rupture, and fetal distress. If labor arrests in the first stage, or if augmentation with Pitocin is unsuccessful, a C-section must be performed.
If your child sustained a birth injury, you need to consult with a healthcare professional right away. They can diagnose your child’s injury and accurately determine the cause. If your case of prolonged labor was mismanaged, you and a Dallas birth injury attorney from Rasansky | McKenzie Law can pursue financial recovery via a medical malpractice lawsuit. We offer a free initial consultation to all prospective clients and can advise you on the best way to move forward with your prolonged labor birth injury case. Call us at (214) 651-6100 to schedule your free consultation.