Slow progress in labour

What is slow progress in the active stage of labour?

Slow progress in labour is when your labour takes longer than expected. It is sometimes called 'prolonged labour'.

When does slow progress in labour happen?

Slow progress in labour can happen during the active first stage and the second stage of your labour.

The evidence on what is 'normal' and what is 'slow' is not strong, and experts have different views on the definitions.

First stage of labour

The first stage of labour is when your cervix softens and dilates (opens). There are 2 parts to this stage:

1. the latent phase — early labour where your cervix begins to dilate.
2. the active phase — you have regular, painful contractions and your cervix opens to 10cm (fully dilated).

The length of the latent phase can vary a lot between people.

The active phase may take up to:

• 8 to 18 hours if you are having your first baby
• 5 to 12 hours if you have had a baby before

Slow progress of labour during the first stage happens when:

• latent phase — lasts longer than 20 hours in a first labour or 14 hours if you've had a baby before.
• active phase — your cervix dilates less than 2cm in 4 hours.

Second stage of labour

The second stage of labour is the time from when your cervix is fully dilated to the birth of your baby.

This second stage could last:

• around 4 hours if you are having your first baby
• around 3 hours if you have had a baby before

Labour is considered slow in the second stage if birth hasn't happened:

• after 2 hours full dilatation or 1 hour of involuntary pushing (having an urge to push) if you are having your first baby
• after 90 minutes of full dilatation or 30 minutes of pushing (involuntary or active) if you have had a baby before

Third stage of labour

The third stage of labour is the time between the birth of your baby and the delivery of your placenta.

The third stage can be managed in different ways, including:

• active management — you take a medicine called oxytocin after your baby is born. This helps your uterus contract, makes the placenta come out more quickly, and lowers the risk of heavy bleeding. This may take around 30 minutes.
• physiological management — you choose to wait for the placenta to come out naturally, without medicine. This may take around 60 minutes.

If your placenta isn't delivered within the expected time, this is called slow progress or a delay in the third stage of labour. Your care team will then discuss your options for medical treatment.

What causes slow progress in labour?

Labour can sometimes take longer for different reasons.

You may be more likely to experience slow progress in labour if you:

• are dehydrated or have a full bladder
• have a uterus with a structural difference (anomaly)
• are living with obesity
• are older or shorter than average
• are having your first birth
• have had an epidural or induction of labour
• have previously had a slow labour or have limited mobility during labour

Sometimes slow progress in labour can happen if your baby:

• is very large for their gestational age
• is in an unusual position in your uterus, called malpresentation
• has a health concern

How is progress in labour checked?

During labour, your doctor or midwife will check how your labour is progressing. They do this through observations and physical checks, which may include looking at:

• how much your cervix has opened (dilation)
• how thin your cervix has become (effacement)
• how far your baby's head has moved into your pelvis
• the strength, frequency and length of your contractions

When checking your progress in labour, your doctor or midwife will also consider your wellbeing and your birthing preferences.

How is slow progress in labour managed?

If your labour is progressing slowly, your midwife and doctor will keep a close watch on you and your baby. If they have any concerns, they will talk them through with you.

Things you can try to help your labour progress include:

• changing positions
• moving around and staying active
• trying relaxation techniques
• using pain relief medicines if you need them

It's important to remember that everyone is different — some people can manage pre-labour (latent phase) for days and cope well, while others find it more difficult. If pre-labour goes on for a long time and you're not coping, your care team may offer an induction to help things progress. Let your health team know your preferences, so you can be actively involved in the decision-making.

As part of shared decision making, your doctor and midwife will discuss your situation with you. They will explain the risks to you and your baby if labour is progressing slowly, as well as the risks and benefits of any treatments they recommend to help speed things up.

This way, you can make an informed decision that is right for you and your baby.

Remember, it is your choice to have any interventions to try to help speed up your baby's birth.

What options might my health team offer?

Depending on what stage of labour you are at and your personal situation, interventions to manage slow progress of labour can include:

• breaking your waters
• giving you a medicine called oxytocin to increase your contractions and make them stronger
• manual rotation of your baby — your doctor or midwife uses their hand to turn your baby's head into a better position
• episiotomy — making a surgical cut in your perineum
• instrumental vaginal birth — forceps or vacuum
• manual delivery of your placenta with surgery

In some cases, your health team may recommend an emergency caesarean if they are concerned about your health or your baby's health.

What are the risks of slow progress in labour?

Slow progress in labour can cause complications for both you and your baby.

Complications of slow labour for you:

• tearing of your uterus
• severe perineal tears
• obstetric fistula
• postpartum haemorrhage
• chorioamnionitis or endometritis
• psychological complications

Complications of slow labour for your baby:

• lack of oxygen to your baby's brain during birth
• respiratory distress syndrome (RDS)
• needing to go to the neonatal intensive care unit (NICU)
• injury during birth — for example a bone fracture
• sepsis (severe blood infection)
• death — this is rare

What are some of the risks of interventions for slow progress in labour?

If you are going through a slow labour, your doctor or midwife will compare the risks of complications from slow labour with the risks of interventions used to help your labour progress. If your risks from slow progress in labour are greater than the risks from interventions, your doctor will discuss these with you and make recommendations.

Read more about the risks of interventions during labour.

Read more about the risks of a caesarean section.

GLOSSARY OF PREGNANCY AND LABOUR — Glossary of common terms and abbreviations used by health professionals in pregnancy and labour.

Will I have slow progress in future births?

Every birth is different. You will not necessarily have slow progress in your next labour. Your first labour will probably take longer than labours that follow.

If you are worried about any future pregnancies, speak with your doctor or midwife.

What happens after my baby's birth?

If your labour did not go to plan, you might feel different emotions about your birth. You may feel stressed and experience anxiety about becoming a parent. This is very common.

If you feel sad, disappointed or distressed by what happened, it is important to talk to someone. You might want to talk with your doctor or a counsellor — they will help you get the care you need.

If you need to talk to someone about your mental health, call Beyond Blue on 1300 22 4636.

Resources and support

• Visit Birth Trauma Australia to access the resources and support they offer to parents who have experienced birth trauma.
• PANDA (Perinatal Anxiety & Depression Australia) offers services and a helpline if you are struggling to cope after your birth. Call 1300 726 306.
• Learn more about the different stages of labour on The Royal Women's Hospital website.
• Safer Baby has a collection of culturally adapted resources about growing a healthy baby, translated into many community languages.
• Visit Birthing on Country for information on projects that support Aboriginal and/or Torres Strait Islander babies and their families.