What Parents Should Know About Prolonged Labor

Most parents expect labor to follow a relatively predictable path. Contractions begin, the cervix dilates, and the baby is born. But labor does not always go according to plan. When labor slows down significantly or stops progressing altogether, it is known as prolonged labor or failure to progress. This is one of the most common complications during childbirth, and it is also one of the most common reasons for a cesarean delivery in the United States.

What many parents may not realize is that a birth injury can occur at any point during labor, including when labor stalls. The longer a baby remains in the birth canal under stress, the greater the risk of oxygen deprivation and other complications. Understanding what prolonged labor is, why it happens, and what medical teams should do about it can help parents recognize when something has gone wrong.

What Is Prolonged Labor?

Labor is generally divided into three stages. The first stage begins with the onset of regular contractions and ends when the cervix is fully dilated to 10 centimeters. This stage is further broken down into the latent phase (early labor) and the active phase. The second stage begins at full dilation and ends with the delivery of the baby. The third stage is the delivery of the placenta.

Prolonged labor occurs when any of these stages takes significantly longer than expected. As a general guideline, labor lasting more than 20 hours for a first-time mother, or more than 14 hours for a mother who has given birth before, is typically considered prolonged. However, the medical definition has evolved over time, and current clinical guidelines focus more specifically on the rate of progress during each phase.

According to the American College of Obstetricians and Gynecologists (ACOG), the active phase of labor begins at 6 centimeters of cervical dilation. Active phase arrest is defined as no cervical change after at least 4 hours of adequate contractions, or 6 hours if contractions are inadequate despite oxytocin augmentation, with ruptured membranes. For the second stage, ACOG defines prolonged labor as more than 3 hours of pushing for first-time mothers and more than 2 hours for mothers who have given birth before, with an additional hour allowed if an epidural is in place.

Why Does Labor Stall?

There are many reasons why labor may slow down or stop progressing. Some of the most common causes include:

Fetal position: The position of the baby in the birth canal plays a significant role in how labor progresses. Ideally, the baby should be head-down with its face turned toward the mother’s back (occiput anterior). When the baby is facing the opposite direction (occiput posterior), or is positioned at an angle, descent through the birth canal can become much more difficult and labor may stall.

Cephalopelvic disproportion (CPD): This occurs when the baby’s head is too large relative to the mother’s pelvis, or when the shape of the pelvis makes it difficult for the baby to pass through. CPD can prevent the baby from descending properly during labor.

Inadequate contractions: For labor to progress, contractions need to be strong enough, frequent enough, and long enough to dilate the cervix and push the baby downward. When contractions are weak or irregular, labor can slow or stall entirely.

Large baby (macrosomia): A baby that is larger than average can have difficulty fitting through the birth canal, which may cause labor to progress slowly or stop.

Epidural analgesia: While epidurals are an effective and common form of pain relief during labor, they can sometimes slow the progression of labor and affect the mother’s ability to push effectively during the second stage.

Maternal exhaustion, anxiety, or dehydration: Physical and emotional factors can influence the body’s ability to sustain effective contractions. A mother who is exhausted or dehydrated may experience a slowdown in labor.

Risks of Prolonged Labor to the Baby

When labor is prolonged, the baby faces increasing risks the longer delivery is delayed. During each contraction, blood flow through the placenta is temporarily reduced. Under normal circumstances, the baby can tolerate these brief periods of reduced oxygen. But when contractions continue for an extended period without adequate recovery time, or when the baby remains in the birth canal for too long, the oxygen supply can become dangerously low. Prolonged pressure on the baby’s head during a stalled labor can also lead to cranial compression injuries, which may cause swelling, bleeding, or further brain damage.

Potential risks to the baby during prolonged labor include:

Oxygen deprivation (birth asphyxia): Sustained pressure on the umbilical cord or placenta during a long labor can reduce the flow of oxygen-rich blood to the baby. As oxygen levels drop, the baby’s blood can become dangerously acidic, a condition known as fetal acidosis. This is one of the most serious risks associated with prolonged labor and can lead to hypoxic-ischemic encephalopathy (HIE), a type of brain injury caused by oxygen deprivation and reduced blood flow. Infants diagnosed with HIE may require therapeutic hypothermia (brain cooling), a time-sensitive treatment that must be initiated within hours of birth to help limit brain damage.

Fetal distress: An abnormal fetal heart rate pattern during labor is one of the most important indicators that the baby is not tolerating the stress of contractions. Signs of brain damage in newborns may become apparent in the hours, days, or weeks following a delivery complicated by fetal distress.

Meconium aspiration: When a baby is under stress during labor, it may release meconium (its first stool) into the amniotic fluid. If the baby inhales this fluid, it can cause serious respiratory problems after birth.

Cerebral palsy and other neurological injuries: Prolonged oxygen deprivation during labor is one of the known causes of cerebral palsy, a group of disorders that affect movement, muscle tone, and coordination. Other long-term neurological outcomes may include seizure disorders, developmental delays, intellectual disabilities, and vision or hearing impairments.

Physical injuries from assisted delivery: When labor stalls, medical teams may attempt to deliver the baby using forceps or a vacuum extractor. If these tools are used improperly or with excessive force, the baby can suffer skull fractures, brain bleeds, nerve damage, or brachial plexus injuries.

What Medical Teams Should Do When Labor Stalls

When labor is not progressing as expected, the medical team has a responsibility to closely monitor both the mother and baby and take appropriate action. Depending on the situation, interventions may include:

• Continuous electronic fetal heart rate monitoring to watch for signs of distress
• Administering oxytocin (Pitocin) to strengthen contractions, with careful monitoring to avoid hyperstimulation
• Performing an amniotomy (breaking the water) to help labor progress
• Repositioning the mother to encourage fetal descent
• Performing a timely cesarean section when vaginal delivery is no longer safe

The decision to perform a cesarean section is one of the most critical decisions a medical team can make during a prolonged labor. Delaying a necessary C-section when the baby is showing signs of distress is one of the most common forms of medical negligence in birth injury cases. When the standard of care calls for an emergency delivery and the medical team fails to act, the consequences for the baby can be severe and permanent.

When Prolonged Labor Becomes Medical Negligence

Not every prolonged labor leads to injury, and not every injury during labor is the result of medical error. However, medical professionals are trained to recognize when labor is not progressing safely and to intervene accordingly. When they fail to do so, it may constitute medical negligence.

Examples of medical negligence during prolonged labor include:

• Failing to recognize or respond to abnormal fetal heart rate tracings
• Allowing labor to continue for too long without adequate intervention
• Mismanaging oxytocin administration, leading to uterine hyperstimulation
• Delaying a necessary cesarean section
• Using excessive force with forceps or a vacuum extractor
• Failing to communicate critical information between members of the care team

These errors can turn a manageable labor complication into a preventable birth injury.

Getting Answers and Support

Birth injury cases involving prolonged labor are medically complex and require a thorough review of labor and delivery records, fetal monitoring strips, and hospital documentation. A birth injury attorney can work with independent medical experts to determine whether the standard of care was met and whether a timely intervention could have prevented your child’s injury. If your child was diagnosed with HIE, cerebral palsy, or another condition following a prolonged or difficult labor, Wais, Vogelstein, Forman, Koch & Norman can help you understand your options. To speak with a member of our team, call 410-998-3600 or contact us online to request a confidential consultation.