If you’re giving birth in a hospital and end up in slow labor, this can put you in a difficult position.
This is especially true if you’re trying to avoid unnecessary interventions.
It’s really important to be informed about what stalled or slow labor means, and what you can do to help yourself.
Otherwise, it can cause a great deal of anxiety and stress, when you least need it.
How is slow labor defined?
Different hospitals have different definitions of ‘slow labor’.
First labors last, on average, between 12 and 18 hours from the start of regular contractions (active phase of labor).
For a second or subsequent baby, the process tends to be much quicker – around 5 to 6 hours.
Your health care provider might consider you to be in slow labor if:
- Your baby isn’t born within 20 hours of regular contractions, or
- Cervical dilation is less than 0.5cm per hour, over a 4 hour period.
Read How Long Does It Take To Dilate From 4cm to 10cm? for more information on the normal progression of labor.
The latent phase of labor
As the muscles in the uterus walls get to work, you’ll start to feel contractions during the latent or ‘early’ phase of labor.
These contractions apply pressure to your cervix, allowing it to expand slowly, or dilate.
What are the signs of slow labor?
The pattern of your contractions can give a lot of information on how your labor is moving forward.
Different patterns of contractions include:
- Slow frequency
- Coupling – where one might start before the last one has completely finished
- Severe back or pelvic pain
- Slow dilation of the cervix
- Poor descent of the head (or presenting part) into the pelvis.
What causes slow labor?
There are a number of causes of slow labor; sometimes, though, the cause is unknown.
Some of the more common reasons for slow labor progress are:
- Big baby – A larger baby might have more difficulty in navigating the pelvis
- Malposition – The baby’s position can affect labor, e.g. back to back or breech
- Contractions – short, weak, or irregular patterns in the first stage of labor
- Medications – Certain medications, including epidural during labor, can affect the duration of labor.
What’s the treatment for slow labor?
At some point, it’s likely there will be (increasing) pressure on you to accept medical augmentation to hurry things along.
This might involve breaking your waters, or medically augmenting your labor with synthetic oxytocin (Pitocin or Syntocinon) might be suggested.
It’s important to understand synthetic oxytocin doesn’t work in the same way as the natural oxytocin your body releases itself.
Artificial oxytocin makes contractions stronger, longer, and more intense, giving you little rest in between.
This increases the chance of your baby experiencing abnormal heart rate patterns.
For you, it increases the likelihood of further interventions, such as additional pain relief in the form of an epidural, or c section birth.
In the first stage or latent phase of labor, some women will experience a plateau. If this happens to you, it doesn’t mean you have done anything wrong; it’s just something that can occur.
The good news is, there are many things you can try, which can help progress your labor, and are also safe for you and your baby.
We recommend reading the following articles for more information:
- 5 Things Oxytocin Does That Pitocin/Syntocinon Doesn’t
- Natural Labour vs Induced Labour – 6 Main Differences.
What to do for a slow labor?
First, you need to understand there are several factors a doctor or midwife will use to medically evaluate the progress of your labor.
These may include any of the following:
- Vaginal examinations to access your cervix, and look for thinning (effacement) and dilation
- Length and strength of contractions
- Time between contractions
- Station or engagement of your baby in the pelvis
- Maternal behavior being displayed (distress, pain).
Unfortunately, none of these methods is reliable or foolproof – even for the most experienced healthcare professional.
Medical staff deal mostly with effacement, dilation, and station. They like to see a regular pattern of progress with regard to dilation.
They’re also mostly involved in managing labors, rather than allowing a woman’s labor to follow its natural course.
Remember vaginal exams are subjective, meaning two people performing the same exam might come up with different results. This can lead to unnecessary interventions or tests, based on their evaluations.
This can happen for a couple of reasons:
- The cervix isn’t visible. Evaluation of the cervix is performed by inserting two fingers into the vagina to assess the cervix. No one has a ruler up there to measure the actual number of centimeters you’re dilated. The number is a ‘best guess’, based on how much of the cervix can be felt
- Sometimes ‘the number’ in terms of centimeters is immaterial. One centimeter of dilation could take 10 minutes or 2 hours – particularly if it’s not your first birth – but the labor can still progress in a healthy way.
There are times when a vaginal exam might be helpful, to check whether your baby’s position is affecting labor or if there’s a particular concern for failure to progress.
Labor doesn’t follow any hard or fast rules and is often affected by many different external factors and influences.
There is growing support, though, that a plateau in labor is very normal and healthy.
Instead of failure to progress, it’s more a case of failure to wait.
With this in mind, let’s see what you can do to get things going:
#1: Go for a walk or mobilize
Movement is a great way to encourage your baby to descend, which involves lots of wriggling and turning through your pelvis.
Movement on your part, especially walking and stair climbing, can help shift your baby into a better position.
Gravity is your friend. It can be really helpful if your baby is in a back-to-back position. Movement allows your baby’s head to put more pressure on the cervix, to assist with dilation.
If you can walk through a contraction, even better! This can be a tricky feat, though, especially later in labor.
#2: Change your environment
When creating your birth space, you might wish to ask yourself:
- Is the room too bright?
- Do I feel closed in or claustrophobic, or need some fresh air?
- Is there too much stimulation, chatter, or annoying noise going on?
- Do I need privacy?
- Do I feel uncomfortable?
- Is anyone making me feel uncomfortable, or is there someone I don’t want to be here?
Your birthing environment has the power to help you relax and feel safe, or to create anxiety.
When you feel stressed, your adrenaline rises. This interferes with your body’s production of oxytocin, the hormone responsible for contractions.
Contractions will slow and stall labor until you’re in a ‘safe’ place again. High oxytocin loves low adrenaline.
If you can, get some fresh air or privacy.
Have a trusted support person who can assess the environment and make changes as needed.
Consider asking for a different doctor or midwife if you’re having trouble relaxing around the one you’ve been assigned.
There are so many things that can mess with the process of labor when you mess with the mother’s right to feel private, safe, and unobserved.
For more information on this topic, be sure to read Undisturbed Labour – What Is It And Why Aim For One?.
#3: Change positions
Try changing positions regularly – every 40-60 minutes or so.
Being stationary, in one position, can slow things down, and make contractions more uncomfortable.
#4: Nipple stimulation
Nipple stimulation to induce labor can produce strong contractions, as the nipple stimulation promotes oxytocin. If you’re breastfeeding a toddler, have him attach, as the sucking action will do the same thing.
Massage the nipple for 5 minutes (when there are no contractions), then wait to see what happens before doing more.
Once contractions are regular again, stop the stimulation.
#5: Sex or orgasm
If you feel up to it, orgasm produces oxytocin, endorphins, and feelings of calm and relaxation. Why not give your partner a nudge (or do it yourself) and get that oxytocin flowing? It might well help labor along.
For some tips on how to manage sex during pregnancy, check out Pregnancy Sex Positions – 7 Ideas For Pregnant Couples.
#6: Acupressure and acupuncture
You can learn acupressure during your pregnancy, so you or your partner can work on acupressure points should you want to get labor moving.
Alternatively, you can speak to an acupuncturist about the possibility of attending your labor or birth. Acupuncture to induce labor is becoming much more popular choice for women.
#7: Consider emotional factors
Childbirth can sometimes bring about big emotions, anticipated or not.
Perhaps you or your partner really wanted a boy and you’re having a girl. Or maybe you’re anxious about pushing your baby out, or recall a horror story from a friend.
Perhaps someone close to you has passed away recently.
Maybe you’re worried about what will happen after the birth, as the pregnancy was unplanned, and you or your partner aren’t sure how you feel about things.
These are all normal emotions to experience during birth. Don’t be afraid or ashamed of them; instead, try to name them. Speak with people you trust to let them know what’s going on.
If you’re aware of any psychological factors that might come up during your labor, exploring them during your pregnancy can be a huge help.
It might be a good idea to seek counseling, to help deal with how you feel and to prevent events playing out when you are in labor.
#8: Wait it out. Yes!
If things are slowing down, the other option is to wait it out.
Medical staff expects birth to happen in a specific time frame, based on an old, outdated method of measuring labor called Friedman’s Curve.
More recent research has shown the average length of the active labor phase is actually 3 hours longer than the expected time frame of the Friedman’s Curve.
This study found 30% of women who were given more time went on to have a normal birth, without harm to themselves or their babies.
#9: Doulas and independent midwives can help
If you’re worried about how you or your partner will remember all of these tips for slow labor, then hiring a doula or independent midwife might be the answer.
A doula is trained in birth support, and can offer techniques and reassurance when you aren’t sure what’s going on, or if you’re feeling anxious.
Studies have shown having doulas or trained birth support people actually promotes oxytocin release. This reduces anxiety and fear, which helps increase your contractions. You’re also less likely to request pain relief.
An independent midwife can do the same, but is also medically trained. That means you can birth at home, if appropriate, or she can accompany you to the hospital.
Midwives have lots of medical and practical knowledge about slow labor, and can help get your labor going again.
If you’re unsure whether a doula is right for you, read 5 Things To Know Before Hiring A Doula to learn more.
Unfortunately, in most hospitals, the most common strategy for dealing with a slow or stalled labor is to fix it with drugs, tools, or interventions.
Who wants to fight for the right to let your body do what comes naturally in labor?
Being prepared with knowledge and the right support is key to having a positive birth experience.