You've assembled a nursery, washed all the tiny clothes and blankets, and composed a birth plan. You feel utterly prepared to give birth to your baby, but what happens if labor stalls? It gets mentioned for a split second in the baby books, but it happens, and it can sound really terrifying.
The average time in labor for new mothers is 12 to 18 hours, according to WebMD, and stalled labor, also known as "failure to progress," may be diagnosed after 20 hours of regular contractions. Personally, I don't like the term "failure to progress" because it sounds like an accusation. You've done everything possible to prepare for this moment and now the doctor says you've failed to do something? It can be heartbreaking, especially if you wanted to have your baby without interventions.
However, you're not alone in experiencing stalled labor, particularly if you're a first-time mom. When I went through orientation at the birth center I'd chosen for my prenatal care, we were warned that something like a third of all women who started their labor at the birth center would be transferred to the hospital due to stalled labor. And in my early days of motherhood, when I spent a lot of time in breastfeeding and new mother groups, I heard more than a few birth stories with climactic midpoints involving stalled labor. More often than not, tales of stalled labor were delivered in a disappointed tone. Those mothers had wanted something different, they'd actively worked in the moment to achieve a different outcome, and yet . . .
The best thing you can do to prepare yourself for the possibility of stalled labor is to understand why and how it happens, and what your doctor might recommend next. Romper spoke with Dr. Adrienne D. Zertuche, OB-GYN at Taylor, Suarez, Cook, Carroll, and Adams (Division of Atlanta Women's Healthcare Specialists), over email to bring you everything you need to know about labor stalling.
First of all, how do doctors define stalled labor? "Obstetricians typically discuss 'stalled' or protracted labor as arrest of dilation or arrest of descent," Zertuche explains. "Both types of arrest can be caused by uterine factors (e.g. weakened contractions), fetal factors (e.g. large or heavy baby), pelvic factors (e.g. narrow bony outlet), or a combination of multiple factors."
When it comes to arrest of dilation, Zertuche says that this "occurs when the cervix stops dilating. Experts previously estimated that the average woman’s cervix dilates 1 to 2 centimeters for each hour that she is in labor. However, more contemporary studies have shown that progress varies according to a number of factors, including the woman’s current cervical dilation, whether the woman has had a baby in the past, and if an epidural is in place." She adds that when deciding whether you need treatment for arrest of dilation, your healthcare provider will consider these factors as well as others, like if you have a fever or ruptured membranes and whether your baby's heart rate tracing is normal.
Arrest of descent is a little different. According to Zertuche, this is when "the baby stops moving downward in the pelvis." She notes that, typically, your OB will diagnose arrest of descent "if you have reached 10 centimeters and have been pushing for at least one to two hours, but the baby does not seem to be moving down in the pelvis or out of the vagina." If your healthcare provider thinks you need treatment for this, they'll consider factors like the effectiveness of your pushing, your baby's position, any signs of an infection, and your baby's heart rate tracing.
So what interventions will your doctor recommend if you experience stalled labor? Zertuche explains:
"For arrest of dilation, the most common interventions are oxytocin (Pitocin) and amniotomy ('breaking' the bag of water). Oxytocin is a synthetic version of a hormone naturally produced by a laboring woman’s brain. This medication is given intravenously and titrated to increase both the frequency and strength of your contractions, while ensuring that the baby’s heart rate tracing remains normal. An amniotomy is when your obstetrician uses a small plastic device to 'break' the bag of water surrounding your baby. This procedure is not painful, and it can stimulate a cascade of events that lead to further cervical dilation. For arrest of descent at 10 centimeters dilation, your obstetrician may have you push in different positions, may rotate an inappropriately-positioned baby, or may offer you operative vaginal delivery with a vacuum or forceps."
Finally, you have to discuss the possibility of a C-section. Zertuche advises that "if you have an arrested or protracted labor that does not respond to these interventions, typically the safest way to have a healthy mom and baby is to deliver by Cesarean section. Your obstetrician will thoroughly evaluate your individual clinical situation and will discuss with you the risks and benefits of continuing to attempt a vaginal delivery before you and he/she decide to proceed with surgery."
As you can see, there are a variety of factors that contribute to stalled labor and none of them are within your control. However, if your labor stalls, it doesn't automatically mean you'll need to have a C-section. You and your doctor can try a variety of medical and non-medical interventions to try to get your labor going again before making the call on whether or not to deliver surgically.