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PROLONGED LABOR

Causes of Prolonged Labor

 

This information is compiled from a workshop on PROLONGED LABOR with midwives Jill Cohen and Sara Liebling. I recommend it be read alongside the notes from the workshop POSTERIOR LABOR by midwife Tricia Anderson, as some issues overlap.

  

 

Obstetric medical texts define PROLONGED LABOR according to Friedman’s Curve of what is “normal”  (primip & multip differ) and have various definitions and rules such as:

“prolonged latent phase” (before active labor) =  over 20 hrs

“protracted active phase”  = less than 1.2 cm/hr  or no progress in 2 or more hrs

“After 5 cm” = no progress in 3 hrs

Other definitions are applied for such terms as “arrest of descent,”  “protracted descent” etc.

 

Midwives, however, agree that there is no such thing as “normal” labor. They observe all women as unique and further observe that the body does what it needs to do. Their definition of prolonged labor is when the midwife and/or the woman feel it is “too long” or when she is discouraged. Midwives see 2-4 days of latent or prodromal labor, many many hours/days of labor, no descent, 5 hrs+ pushing, and still arrive at outcomes of normal vaginal birth.

 

There are many causes/reasons for prolonged labor, and the Midwife tries to figure out WHY.  Three general areas are observed: 

Physical, Emotional, and Social.

 

1. PHYSICAL CAUSES

- Malpresentation and Posterior Presentation

Reasons include: abdominal musculature, placental position, uterine fibroids, abnormal uterine shape, prematurity, too much fluid, breech, poor flexion of head, face/brow presentation, compound presentation

- Asynclitism (baby’s head is deflexed and tilted sideways)

- Disproportion- pelvis type & size/fit of baby (android & platypelloid have poorer prognosis). (Studies are being done regarding cultural cross-typing that are showing that not being built the same can be a factor in producing larger babies or disproportion, but also showing other factors such as attitudes about birth in other cultures and diet in other cultures that make smaller babies). 

- Different types of contractions.

- Increased cervical resistance - prior biopsy, conization, surgery. 

 

- SEE ARTICLE ON POSTERIOR LABOR and info on pelvic types 

(Remember- pelvises change, move, and open.)

 

 

2. EMOTIONAL / PSYCHOLOGICAL CAUSES

 

- Fear (parenthood, unknown, pain, etc.)

Fear is probably the leading factor of prolonged labor in the U.S.  (Some is appropriate natural fear). Hopefully women can have opportunities to work through fears prenatally.

- Abuse issues; she has been out of control of her body and her sexuality (Epidural may be [appropriate] choice to have no pain)

- CONTROL issues. Women want to maintain control and are not able to let go, release [the baby].

What helps: water, bath, warm compresses. Put her in a warm, safe place. Water (if available) is also a buffer against electronic interferences in a hospital setting. Sooth the psychological issues, if possible.

 

 

3. SOCIAL CAUSES

 

- WHO is at the birth? Should be addressed in advance! Is there a mother who is “babying” her [laboring] daughter? Other in the environment can slow labor down. Get them out if the energy is interfering. 

- Some women need to be alone, others like lots of people. In terms of the couple relationship, we’ve fought so hard to get partners in - in fact we insist on it -  she may prefer only women. 

- Who is there that the woman does not like? Perhaps you need to remove your SELF (doula/midwife)?  Everyone is tired in a prolonged labor. Send people (& self) out to revitalize. 

- Some women may need a moment of “tough love.” Hard sometimes for support people to accept, but she could be slowing her own labor down by focusing on her own suffering or demanding to be catered to.

 

The midwives then discuss various homeopathic remedies that they employ in prolonged labors and find very successful, including Bach Flower Remedies, Rescue Remedy, Evening Primrose Oil, and aromatherapy.

 

In a prolonged labor they also have the mother use/try all possible positions for both progress and conserving energy, such as: straddling a chair & resting with feet up, sitting on the toilet backwards w/pillows.

 

 

 

 

 

 

 

 

 

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