Why Is My Labor Slow? Understanding Prolonged Labor

I remember a young woman, Sarah, so excited for her first baby. She’d done all the classes, her bag was packed for weeks. Labor started, and everything seemed to be on track. But then… the hours just kept stretching on. Contractions came and went, but the progress her midwife was hoping for just wasn’t happening. “Why is this taking so long?” she whispered, her voice tired but anxious. That feeling, that worry when things slow down, is something we see sometimes. It’s often what we call prolonged labor, or “failure to progress,” and it’s completely understandable to feel a bit overwhelmed if it happens to you.

So, what exactly is prolonged labor? Think of it this way: your body is working hard, but labor isn’t moving forward as expected. This can happen in the first part of labor, when your cervix – that’s the opening to your womb – is supposed to be opening up. Or, it can happen in the second stage, when you’re pushing and your baby is making their way down the birth canal.

We generally consider labor to be prolonged if it lasts more than about 25 hours for first-time moms, or more than 20 hours if you’ve had a baby before. Now, typical labor can be a marathon too – often 12 to 24 hours for a first baby and maybe 8 to 10 for later ones. So, prolonged labor is when it goes significantly beyond that.

It’s not incredibly common, affecting around 8% of births, but it is one of the reasons why a C-section (Cesarean birth) might become the safest option for you and your baby.

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Why Does Labor Sometimes Slow Down?

It’s completely natural to ask, “Why is this happening to me?” There isn’t always one single answer, but here are some common reasons labor might slow down.

During that first stage, when your cervix is working on opening (we call this dilation and effacement – thinning out):

Sometimes, those uterine contractions just aren’t quite strong or regular enough to do the job efficiently. Your body might just need a little encouragement.
Less often, certain pain medications, if given very early in labor, might unintentionally weaken contractions for a bit.

If things slow down in the second stage, when you’re actively pushing:

Your baby might be a bit on the larger side, or your pelvis might be a bit snug for them to pass through easily. It’s all about the fit!
The baby’s position can play a big role. If they’re facing your front instead of your back (we sometimes call this “sunny-side up”), it can make the journey a bit trickier.
Those contractions might lose some of their power just when you need them most.
And let’s not forget the mind-body connection. Feeling very anxious, stressed, or fearful can, believe it or not, sometimes impact how labor progresses. Your emotional state is powerful.

What about things like smoking? Well, we always advise against smoking during pregnancy for many reasons. Some studies have suggested that moms who smoke might experience prolonged labor more often.

And a common question I get: “Will an epidural make my labor longer?” Generally, no. In fact, for some women, the relaxation an epidural provides can actually help the first stage of labor move along more smoothly.

When Labor Lingers: Signs and Potential Concerns

The main sign of prolonged labor is pretty straightforward: time. A lot of time passing without your labor moving from one phase to the next. If you feel like you’ve been in active labor for what seems like forever, and your care team confirms things aren’t progressing, that’s when we start talking about it.

Now, if labor does stretch out, we become extra watchful for a few things, for both your health and your baby’s.

For You, Mom:

Infection: The longer your water has been broken, the slightly higher the chance of an infection developing.
Increased bleeding after birth: This is something called postpartum hemorrhage.
Future pelvic issues: Very long labors can sometimes, down the road, contribute to things like urinary incontinence (leaking pee) or pelvic organ prolapse (where pelvic organs can shift).
Uterine rupture: This is very rare, but it’s a serious concern where the wall of the uterus tears. We monitor for this closely.
A higher chance of needing a bit of help with delivery, like using a vacuum or forceps, or needing a cesarean birth (C-section). And remember, if that happens, it’s to ensure the safest outcome.

For Your Baby:

We’re keeping a very close eye on your little one too. Potential concerns include:

Infection: Just like for you, if an infection starts, it can sometimes pass to the baby.
Fetal distress: This means your baby might be showing signs they’re not coping well with the long labor, often seen as changes in their heart rate.
Lack of oxygen (perinatal asphyxia): We work hard to prevent this, as it can happen if the labor is very difficult or prolonged.
Shoulder dystocia: This is when the baby’s head is born, but one of the shoulders gets stuck. It’s an emergency we’re trained to handle.

It sounds like a lot, I know. But please hear me: your medical team is trained to anticipate and manage these risks. We’re there with you.

Figuring It Out and Getting Things Moving

So, how do we actually know if your labor has stalled, and what can we do to help?

First, we keep a close watch on your progress. This usually involves:

Regular cervical checks: Your doctor or midwife will gently examine your cervix to see how much it’s dilated (opened) and effaced (thinned out).
Tracking your baby’s descent: We’re also checking to see if your baby is moving down through the birth canal.

If it’s been more than 20 hours (if you’ve had a baby before) or 25 hours (for first-timers) of contractions, and your cervix isn’t changing or your baby isn’t moving down, we’ll likely diagnose prolonged labor. (This timeline might be a bit different if your labor is being induced, by the way.)

Okay, So What Can We Do?

If things are dragging in that first stage, when your cervix is meant to be opening, we might suggest a few things to give your body a nudge:

Breaking your water (amniotomy): If your amniotic sac (the bag of waters) is still intact, sometimes releasing the fluid can help speed things up.
Medication to help contractions: Most commonly, this is oxytocin (you might hear it called Pitocin®). It’s a synthetic version of the hormone your body naturally produces to make contractions stronger and more regular.
Relaxation techniques: A warm bath or shower can do wonders for helping you relax, which can sometimes get things back on track. Movement, like walking if you’re able, can also help.

If you’re fully dilated (10 centimeters – yay!) but your baby isn’t making much headway during the pushing stage (the second stage):

Try different positions: Sometimes shifting how you’re positioned can help your baby navigate the pelvis.
Take a breather: Labor is hard work! Sometimes a period of rest can help you (and your uterus) regroup.
Oxytocin again: If contractions have weakened, we might use oxytocin to give them a boost.

We’ll always talk through all these options with you and your birth partner, making sure you understand what we’re recommending and why. The goal is always a safe delivery for you and your baby.

The Journey Through a Longer Labor & Looking Ahead

Experiencing prolonged labor is, without a doubt, exhausting. It can be a real test physically, mentally, and emotionally. I’ve seen so many strong women navigate this, and it’s okay to feel all the feelings – frustration, worry, tiredness.

Your healthcare team will be right there with you, constantly checking on you and your baby. We’ll be monitoring your progress, your baby’s heart rate, and discussing any interventions like oxytocin if needed.

The absolute best things you can do?

Rest when you can. Even small breaks matter.
Lean on your support person. Let them advocate for you, comfort you, and just be there.
Try to stay as positive as possible. This is so much easier said than done, I know, but focusing on meeting your baby can be a powerful motivator.

Are Some People More at Risk?

There are a few things that might make prolonged labor a bit more likely, though it can happen to anyone:

Carrying multiples (like twins or triplets).
The way your baby is positioned in the womb as labor starts.
Older maternal age.
Having a high body mass index (BMI) before or during pregnancy.

Can You Do Anything to Prevent It?

Some of these risk factors are things you can chat with your doctor about beforehand. For instance:

Focusing on healthy weight gain throughout your pregnancy is always a good idea for many reasons, and it might help here too.
If your baby is in a less-than-ideal position for birth, sometimes your provider can suggest ways to encourage them to turn, or even try to help them rotate during labor.

But other factors, like your age or if you’re expecting more than one baby, well, those are just part of your unique story.

The most valuable thing? Talk openly with your doctor or midwife before your due date. Go over your birth plan, yes, but also discuss the ‘what ifs.’ Understanding how your team approaches situations like prolonged labor can bring a lot of peace of mind. Knowledge is power, especially when you’re heading into such an important experience.

Key Things to Remember About Prolonged Labor

If your head is spinning a bit (totally understandable!), here are the main takeaways:

Prolonged labor means labor is taking much longer than average, either for your cervix to open or for your baby to be born.
It can happen for various reasons, like the baby’s size or position, or contractions that aren’t strong enough.
While it can be tiring and sometimes lead to interventions like a C-section, your medical team is there to monitor you and your baby closely.
There are things we can do to help labor progress, like medication (e.g., oxytocin) or suggesting position changes.
Open communication with your healthcare provider before and during labor is key. Don’t hesitate to ask questions about prolonged labor.

Remember, if you find yourself on a longer-than-expected labor journey, you’re not alone, and you’ve got a whole team dedicated to helping you through it safely.