Failure to progress

We are all different, so what is it that causes some women to labour at a slower rate than others? And when does it become a problem?

NO WOMAN KNOWS for sure how long her labour will be, and anything from six to 24 hours is considered the norm. What many women don’t understand is that although a labour may have lasted 16 hours, it is not 16 hours of bent-over, doubled-up pain. Labour starts quietly and slowly in most cases and should give you time to warm up, and get to a place of safety. Early labour is all about getting your attention and getting you focused before the real intensity starts. Many things influence how you’ll labour on the day. Your baby has a lot to do with what happens and what the outcome will be. It is important to keep an open mind, as nothing about labour and birth is predictable, and things can happen in an instant that could change the course of labour. It is unfair for caregivers to expect all women to labour in the same time. Hormones control the start and maintenance of labour, and it is the disturbance of the balance of these that can cause labour to slow or stall.

WHAT IS A SLOW LABOUR?

Many caregivers use the set standard of 1cm dilation per hour in labour (after 3cm) to be the normal course of a labour.

If you are taking longer than this time, you may be considered by your doctor to have a slow labour.

It is not dangerous to labour slowly. In fact, sometimes it is more manageable and tolerable when your body can take its own time to open. However, the slow labour or “failure to progress” is a frequent reason we are unable to achieve a natural birth. We put too much pressure on a woman and her body to do things according to a set scale, when clearly we are all different and each of us will go through this experience in our own way and our own time, if allowed. The biggest cause of a slow or stalled labour is fear. When you’re feeling observed,

have bright lights around you, noise and forms and papers to fill in, questions to answer and in a strange, medical environment, it’s natural to get tense and anxious, which in turn causes your body to put the brakes on labour. If you’re going into labour, you shouldn’t be subjected to all of the above and should be encouraged to be relaxed, quiet, in a dimly lit room with your support team around you. When catecholamines enter your system, your body goes into flight or fright mode and your labour will stall immediately. Your primal brain (where birthing should take place) picks up distress signals from your body and sends chemical messengers to slow or stop the labour until such time as the mother is “safe” to continue labouring. If you’re anxious or fearful, you may be acting or reacting fearfully. To overcome this challenge, it will be necessary to help you feel safe and comfortable again.

A doula or other support person and your midwife can work miracles in getting you to feel safe and at ease enough to kick-start labour again. You’re also at risk if you’re poorly hydrated. Take sips of water or juice or suck on ice chips between contractions. The stalled/slow labour may indicate a problem with the baby’s position, such as an asynclyntic (head not pressing fully on the cervix) or posterior presentation. Often, a baby in a poor position will cause an irregular contraction pattern with short and painful contractions.

If this is the case, it may be helpful to use positions and techniques that may help to realign the baby in the pelvis. This should be taught in antenatal/ childbirth-education classes along with other self-help and coping techniques. A slow labour can be exhausting, depleting the energy you need to handle the intensity of labour.

If you find yourself in a slow labour, it’s important to take regular rest times and sleep between contractions, if the pattern allows.

Most slow labours are not more painful, but can sap your energy levels, especially if you’re anxious.

Some caregivers may encourage the mother to use Pitocin, rupture the membranes artificially or apply other medical labour stimulation techniques to effect faster dilation. If dilation still does not conform to what the caregiver believes should happen, you may be considered “failure to progress”, and a caesarean section would be recommended. So what can you do to possibly help prevent this?