What is slow progress in labour?

Slow progress in labour is when any of the stages of your labour take longer than expected. It may also be called failure to progress or prolonged labour.

Slow progress in labour can be difficult to define. This is due to variations in labour for different people and the evidence available to support this. It’s important to note that when labour progress is checked, many factors are taken into consideration. This includes the wellbeing of both you and your baby. Your birthing preferences are also important.

Your healthcare team will assess labour progress through observations and physical examinations, including:

• cervical dilatation (opening of the cervix)
• cervical effacement (thinning out of the cervix)
• lowering of your baby’s head in your pelvis
• increasing strength and duration of your contractions

Slow progress in labour can be risky to both you and your baby.

What are the causes of slow progress in labour?

Slow progress in labour may be more likely if your:

• the baby is large
• the baby has a large head
• the baby is in a difficult position
• contractions aren’t strong enough and your cervix doesn’t open (dilate)
• pelvis is too small to fit your baby through

You may also have a greater chance of slow progress in labour if:

• you are overweight
• you have gained a lot of weight during your pregnancy
• this is your first baby

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 happens in 3 phases:

1. the latent phase
2. the active phase
3. the transition phase

This stage of labour often stops and starts. It may take up to:

• 12 hours if it’s your first baby
• 10 hours if you’ve had a baby before

Sometimes your contractions won’t be strong enough to dilate your cervix fully. This happens when:

• your cervix doesn’t dilate by about 1cm every hour
• your labour stops altogether

If this happens, your doctor might talk with you about options to intervene and get your labour moving. You have the right to make your own choices about the interventions you want.

Second stage of labour

The second stage of labour is the time between full cervical dilatation (10cm) and the birth of your baby.

This stage could last:

• up to 3 hours if it’s your first child
• up to 2 hours if you’ve had a baby before

If the second stage of labour is taking longer than expected, your doctor will talk with you about your options. They may recommend intervening. It is your choice to have any interventions to help speed up the delivery of your baby.

Third stage of labour

The third stage of labour is the time between the birth of your baby and the delivery of the placenta. This usually lasts about 30-60 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 the risk of postpartum haemorrhage (bleeding after the birth). Your midwife or doctor will 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.

This is optional and some people choose to deliver the placenta naturally without intervention. This is called physiological management.

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.

If you are in the first stage of labour, your midwife and doctor may recommend:

• breaking your waters
• giving you a medicine called oxytocin

This will speed up your contractions and make them stronger.

Other things you can try to help your labour progress include:

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

If your baby has already entered your birth canal, your doctor may suggest delivering your baby using: forceps or ventouse (vacuum cup).

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

What are the risks of slow progress in labour?

Sometimes, slow progress in labour can result in health issues for you and your baby.

What are the risks to my baby?

The risk of slow progress in labour to your baby depends on many factors. Your healthcare team will explain any concerns they may have about your baby’s health.

They may have an increased risk of:

• low oxygen levels
• abnormal heart rhythm
• meconium (poo) in the amniotic fluid
• infection (when germs get in their body)

If meconium (poo) is in the amniotic fluid, this can be a sign that your baby is distressed. Meconium is your baby’s first poo and is very sticky and tar-like. Babies usually have their first poo after they are born. But some babies who are stressed during labour may pass meconium when they are still in the womb. If this happens your baby might breathe in amniotic fluid containing meconium. This can make it difficult for them to breathe after birth. When they are born they may require special care.

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.

What are the risks to me?

Slow labour can increase the risks of post-partum haemorrhage and uterine infection. Assisted delivery can 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.

Your medical team may suggest an emergency caesarean if other interventions don’t work. As with any type of surgery, there are some risks. At this point a caesarean is usually the safest option for both you and your baby.

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
• Perinatal Anxiety & Depression Australia (PANDA) on 1300 726 306
• Australasian Birth Trauma Association
• Beyond Blue on 1300 22 4636

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.

If you’re worried about any future pregnancies, you should talk to your doctor or midwife. They can explain what happened and discuss any further pregnancy risks.