What is slow progress in labour?

Slow progress in labour is when your labour takes longer than expected. It may sometimes be called 'failure to progress' or 'prolonged labour'.

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How is progress in labour checked?

Your healthcare team will assess your labour progress. This can be done through observations and physical examinations to assess:

• dilation (opening) of your cervix
• cervical effacement (thinning out of your cervix)
• lowering of your baby's head into your pelvis
• the strength, frequency and duration of your contractions

It's important to note that when labour progress is checked, many factors are considered. This includes the wellbeing of both you and your baby. Your birthing preferences are also important.

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When does slow progress in labour happen?

Slow progress in labour can happen at any stage of your labour.

First stage of labour

The first stage of labour is when your cervix softens and dilates (opens). It includes:

1. the latent phase (early labour where your cervix dilates up to 5cm)
2. the active phase (when you are having regular, painful contractions and your cervix opens from 5cm to fully dilated at 10cm)

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

The active phase may take up to:

• 18 hours if it's your first baby
• 12 hours if you've had a baby before

Slow labour is when there is less than a 2cm increase in the dilation of your cervix over a 4-hour period during the active phase.

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 stage could last:

• 2 to 3 hours if it's your first child
• 1 to 2 hours if you've 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.

This usually lasts about 30 to 60 minutes, depending on how this stage is managed (active or physiological). This stage of labour is carefully supervised.

Active management of labour is recommended to reduce your risk of postpartum haemorrhage (bleeding after the birth). Your midwife or doctor will ask to give you an injection of a medicine called oxytocin after your baby is born. They will clamp and cut the umbilical cord and apply gentle traction to the cord to deliver the placenta.

Some people choose to deliver the placenta naturally without intervention. This is called physiological management.

Your doctor or midwife will discuss active and physiological management of the third stage with you during your pregnancy. They should tell you about the benefits and harms of each, to help you make an informed choice about what you would prefer.

If the placenta is not delivered within the expected time, you may need to have it removed.

How is slow progress in labour managed?

If you have slow progress during labour, your midwife and doctor will monitor you closely.

They will measure:

• how much your cervix is dilating
• how long your contractions last
• how often you are having contractions

They will continuously check the health of both you and your baby. If there are any concerns, these will be discussed with you.

Things you can try to help your labour progress include:

• changing position
• moving around and staying active
• relaxation techniques
• pain relief

If you have slow progress in the first stage of labour, your midwife and doctor may consider:

• breaking your waters
• giving you a medicine called oxytocin to speed up your contractions and make them stronger

If your baby has already entered your birth canal, your doctor may suggest delivering your baby using forceps or ventouse (vacuum cup). They may recommend these options in some cases if your health or your baby's health is at risk.

In some cases, an emergency caesarean may be recommended if there is concern that you or your baby are unwell.

Your doctor and midwife will discuss any of these measures with you and their risks and benefits. You have the right to be involved in the decisions about any interventions you want — this is called shared decision making.

It's your choice to have any interventions to try to help speed up the delivery of your baby. Your informed consent is needed for all treatments or procedures, unless it's an emergency.

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

If either forceps or ventouse are used to help you have your baby, there is a risk your baby may have some swelling or marks on their head. These usually fade quite quickly.

Assisted delivery can also injure the mother, but most injuries will be temporary and will heal over time. Sometimes, the injury can be more long lasting and may need further treatment.

As with any type of surgery, there are some risks with 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 pregnancy and birth are different. You won't necessarily have slow progress in your next labour. First labours usually take longer than subsequent labours.

If you're worried about any future pregnancies, you should talk to your doctor or midwife.

What happens after my baby's birth?

If your labour didn't go to plan, you might feel different emotions about your birth. You may feel stressed and experience anxiety about motherhood.

If you feel sad, disappointed or distressed by what happened, it's important to talk to someone. You might want to consider contacting:

• your doctor or midwife
• the hospital, to schedule a birth debrief
• PANDA on 1300 726 306
• Australasian Birth Trauma Association

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