Very often when talking to mothers during the postnatal period, I hear them talk about fail to progress in labour, no progress in labour, getting stuck at 5 cm dilated and really all of the above terms are vague and don’t come across very positive for mothers. If you are not progressing in labour it can mean your cervix is not dilating, or your baby’s head is not moving down the birth canal or both which can all result in slow labour.
- When does labour officially start?
- How long is a normal labour?
- What is a slow labour?
- Why might my labour be slow?
- How might my labour be speeded up?
- Can I speed up my labour myself?
- What can help me cope with a long labour?
When does labour officially start?
Midwives and doctors say your labour actually starts when:
You have regular painful contractions and your cervix is dilating progressively from 4cm onwards.
When this is happening you are starting the active phase of the first stage of labour.
This may surprise many girls, as you will be experiencing painful tightenings well before this stage. You may have been awake all night feeling labour has been going on for a while. This is very common in your first pregnancy.
How long is normal labour?
The average length of the active stage of labour for a first baby is about 8 hours, but it could be shorter or longer. First babies can take their time, but it’s unlikely that the active first stage will be longer than 18 hours.
If this is not your first baby you may have a shorter labour than the first time round, but this is not guaranteed. For women who have given birth before, the active first stage of labour lasts on average 5 hours and is unlikely to last more than 12 hours.
The second stage or the pushing stage shouldn’t take more than 3 hours or less than 2 hours if you have had a baby before.
A quick labour isn’t always better for you or your baby. Very fast labours can be physical and emotionally challenging. Although a very slow labour may cause you and your baby to become exhausted.
What is a slow labour?
During active labour there may be an hour or so of slow or little progress followed by periods of faster progress. What matters is how your labour progresses over several hours.
If your labour is straightforward, you midwife will assess how your labour is progressing every approximately 4 hours. With your permission she will conduct an internal examination to check how many cm your cervix is dilated. She will also listen into the baby’s heartbeat, check your blood pressure, and continue to monitor you throughout labour.
A 4 hourly check of your cervix gives the midwife an overview of how your labour is progressing and reduces your chances of having an unnecessary caesarean section.
However, if you have had any health concerns during this or a previous pregnancy you may need continuous monitoring of the baby’s heartbeat. It is also recommended if you have any labour complications such as meconium (baby’s first poo) in your waters or fresh vaginal bleeding.
Your midwife will place 2 electronic sensors on your bump, one to measure the contractions and one to measure the baby’s heartbeat. They will remain there for labour. She will also check your cervix every 4 hours.
If your cervix is not dilating at a rate of at least 0.5cm per hour over a 4hour period speeding up your labour may be an option. This is called augmentation of labour. Your midwife will discuss whether or not to speed up your labour with you and your doctor.
Each woman’s labour is unique and your wishes should be taken into account along with what your midwife and doctor recommend is best for you and your baby.
Why might my labour be slow?
Some labours are just slow for no particular reason. However, you may have a slow labour if:
You are dehydrated or exhausted
The position of your baby is not ideal
You feel particularly scared or anxious and these emotions are interfering with the release of labour hormones.
Your contractions are infrequent, not very strong or staying the same intensity rather than getting stronger.
You have a tall and narrow pelvis (android pelvis). This may cause your baby to settle into a back to back (posterior) position. About 1 in 5 women have an android pelvis.
You have interventions that have slowed your contractions. These could include having to stay still for periods of time or having an epidural.
Bear in mind that the first 5cm of cervix dilation nearly always takes much longer than the second 5cm. Your cervix opens more quickly as your contractions get stronger.
How might my labour be speeded up?
Breaking the waters
Your midwife may suggest breaking your waters to speed up your labour. This isn’t usually recommended near to the beginning of labour as it could increase the risk of infection if labour doesn’t start right away.
However, if the active stage of labour slows right down, breaking the waters can help get things going again.
If you agree to the procedure this is how your midwife will do it: once you are on the bed she will remove the last section of the bed so that your bottom is right at the end of the bed. She will help you to put your legs up on to stirrups or just hold them apart. Your midwife will then make a small break in the bag of membranes around your baby. She will use a long thin probe (amnihook). She will scratch the membranes until it bursts and the waters flow out.
This procedure isn’t painful but it can be uncomfortable. You will probably be glad to get up again once it is over.
The midwife will then check your baby’s heartbeat to make sure breaking the waters hasn’t distressed him.
Your contractions may become much stronger after your waters have broken. Be prepared to work hard with your breathing and relaxation exercises that you have learned during your classes www.antenatalonline.ie You can also ask your midwife for some other form of pain relief if you need extra help.
If moving around and breaking your waters doesn’t speed up your labour your doctor may suggest a hormone drip to make the contractions more effective. This will contain syntocinon which is an artificial form of the labour hormone oxytocin.
If you have syntocinon your midwife will continuously monitor your baby’s heartbeat by strapping electronic sensors to your tummy.
Your midwife may also recommend attaching a small clip to your baby’s head. Ths clip is called a fetal scalp electrode. It may provide a more accurate reading of your baby’s heartbeat than placing a sensor on your tummy. It also allows you to move around more easily in bed.
Continuous monitoring is recommended because syntocinon can over stimulate the womb. You may get strong frequent contractions which could distress your baby. You are also more likely to need help from pain relieving drugs to cope with these artificially induced contractions. Your midwife may discuss an epidural with your before she starts the syntocinon drip.
Can I speed up my labour?
If your midwife asks whether you would like to have your labour speeded up, take time to consider your options. If your baby is well and your cervix is gradually opening up even if it is happening slowly, it may be best to leave things alone.
You may be perfectly happy to take things gently, staying in tune with your body and baby. Or you may be totally exhausted that you want your baby born quicker.
You could try some of the following:
If you are lying in bed, get up. Being upright and mobile may strengthen your contractions while also helping you to cope with them.
Take a walk to the toilet. A full bladder may slow labour by getting in the way of baby’s head descending.
Get into a warm bath. This can help reduce your need for an epidural or other pain relief.
If your baby is lying back to back an experienced midwife may advise you to lie on your side, or try kneeling or standing lunge position. This may help your baby rotate to a better position for birth.
Have some private time with your partner, turn the lights down low, and have a cuddle. This may help your body to release oxytocin the hormone that strengthens contractions.
You could also try some acupuncture or hypnosis during labour.
Complimentary therapies probably work best if used throughout labour.
What can help me cope with a long labour?
These may help you cope and relax:
Use breathing and relaxation techniques to help you stay calm and focused.
Ask your partner to massage your feet or back
Listen to your favourite music
Eat and drink what you are allowed to, isotonic drinks or water help you stay hydrated.
Change your position. Later in labour you may not feel like walking around but your midwife can help you find a comfortable position.
Rock your hips and lean forward during contractions to help your womb to push your baby firmly down on to your cervix.
Talk to your midwife ask her to explain what is going on. If you feel involved and in control of your labour, you will probably feel less anxious and more relaxed. This may make your labour easier to cope with and you may find it a more positive experience.