Prolonged Labor (Failure to Progress)

What is prolonged labor?

Labor that progresses slowly is known as prolonged labor or failure to progress. It can happen during the first or second stages of labor. You may be in labor for many hours without moving to the next stage. The goal of treatment for prolonged labor is to keep you and your baby healthy and help you deliver your baby safely.

How many hours is considered prolonged labor?

Prolonged labor is when labor lasts:

• 25 hours or more for those having their first baby.
• 20 hours or more for those who’ve had at least one baby in the past.

In contrast, typical labor lasts (on average) 12 to 24 hours for a first birth and 8 to 10 hours for subsequent births.

What happens during prolonged labor?

During prolonged labor, either:

• The cervix, part of the female reproductive system, starts to dilate (open) but stops before it’s fully dilated to 10 centimeters.
• The cervix has fully dilated, but the baby stops moving down the birth canal.

How common is prolonged labor?

Prolonged labor isn’t common — it affects about 8% of people giving birth. However, it causes about one-third of all cesarean births (C-sections).

What are the risks of prolonged labor?

Failure to progress during the first stage of labor rarely leads to complications, although it’s often mentally and physically draining for the parent. Prolonged labor during the second stage is more serious because it increases the risk of:

• Infection.
• Postpartum hemorrhage.
• Future incontinence.
• Future pelvic organ prolapse.
• Uterine rupture (very rare).

Prolonged labor increases your chances of needing a different type of delivery. For example, your healthcare provider may need to use medical instruments, like a vacuum or forceps, to help deliver your baby. Prolonged labor also increases your chances of having a C-section.

Can prolonged labor affect the baby?

Prolonged labor can increase risks to your baby, including:

• Infection (usually passed from parent to baby).
• Fetal distress, a drop in heart rate.
• Perinatal asphyxia, lack of oxygen.
• Shoulder dystocia (getting stuck in the birth canal).

What are the causes of prolonged labor?

The first stage of labor is the time from regular contractions until your cervix is fully open. The second stage is the time from when your cervix is fully open until the baby is delivered.

During the first stage of labor, your cervix thins (effacement). Slow effacement can increase your time spent in labor. The cause of slow effacement is usually inefficient uterine contractions. Sometimes, certain medications used during labor (such as morphine, when given early in the labor process) can weaken contractions, slowing the birth process.

The second stage is considered to be prolonged if it lasts more than three to four hours in a first-time parent or two to three hours if you’ve had a baby before.

During the second stage, prolonged labor can happen if your:

• Baby is too large.
• Birth canal is too small.
• Pelvis is too small for your baby to move down.
• Uterine contractions aren’t strong enough.

Research has also linked prolonged labor with psychological factors during labor like anxiety, stress and fear.

Can smoking slow down labor?

Smoking doesn’t necessarily cause prolonged labor. But some studies have shown that people who smoke have a higher rate of prolonged labor than those who don’t.

In one study, those who smoked also had a higher rate of cesarean section. Healthcare providers recommend you quit smoking before pregnancy since smoking during pregnancy can cause problems for you and your baby.

Do epidurals prolong labor?

No. There’s no correlation between epidurals and prolonged labor. Some evidence shows that epidurals can even speed up the first stage of labor by helping you relax.

What are the signs that I have prolonged labor?

The main sign of prolonged labor is spending a long time in each stage with little to no progression. If you’re in labor for more than 25 hours (for your first baby) or 20 hours (if you’ve had a baby before), your labor is prolonged.

How do I know if I have failure to progress during labor?

Your healthcare provider can tell if you have failure to progress by checking your cervix for effacement and dilation. In the first stage, your cervix should dilate to 10 centimeters. Once you reach the second stage, your baby should move down the birth canal. If your baby isn’t born after 20 total hours of contractions, you’re most likely in prolonged labor. The time you spend in labor may be longer if your labor is being induced.

How is prolonged labor managed?

If you’re in prolonged labor during the first stage, the goal is to encourage stronger contractions to help dilate your cervix. Your healthcare provider may recommend:

• Nipple massage, if appropriate, to help your body naturally release more oxytocin, which encourages stronger contractions.
• Breaking your water or artificial rupture of membranes (AROM), also called amniotomy.
• Medication, such as oxytocin (Pitocin®) or other medications to help ripen your cervix.
• Taking a warm bath to relax.

During the second stage of labor, your provider may recommend that you:

• Change positions often or take a walk.
• Rest and relax.
• Start medication such as oxytocin.

What are the risk factors for prolonged labor?

Certain factors increase your risk of experiencing prolonged labor, including:

• Carrying multiples.
• Your baby lying in certain positions.
• Older maternal age.
• High body mass index (BMI).

Can I reduce my risk of prolonged labor before labor starts?

Some risk factors for prolonged labor can be changed. For example, you can talk to your healthcare provider about gaining a healthy amount of weight throughout pregnancy. That’s one way to lower the risk of prolonged labor since a high BMI can increase your risk.

During labor, if your baby is head-down but facing your front, it’s harder for your baby to move through your pelvis. Your provider may be able to rotate your baby to the correct position, better allowing the baby to pass through your pelvis.

However, other factors can’t be changed, such as your age or if you’re expecting multiples. Talk to your support person and healthcare team before the birth to discuss your birth plan, including the possibility of prolonged labor and how to manage it.

What can I expect if I have prolonged labor?

Prolonged labor is exhausting — physically, mentally and emotionally. If you experience prolonged labor, your healthcare provider will monitor your status with frequent cervical checks. They may recommend various medications, like oxytocin, to encourage labor progression. Your healthcare team will also closely monitor the baby to quickly detect any distress.

The best thing you can do during prolonged labor is rest, lean on your support person and stay as positive as possible.

What questions should I ask my provider about prolonged labor?

Prolonged labor happens rarely, but if you’re at high risk, you may want to ask your provider about the possibility of this scenario. Questions to ask can include:

• Am I at high risk for prolonged labor?
• Are there steps I can take to reduce my risk?
• What position is my baby in?
• If my baby isn’t in the right position for delivery, are there ways to rotate them?
• How do you manage prolonged labor?
• What pain management techniques do you offer?

A note from Cleveland Clinic

Labor that lasts 20 hours or more may seem long, but your healthcare team will work with you toward one goal: a healthy delivery for both you and your baby. Talk to your provider about their approach to prolonged labor. Bring up any questions or concerns you may have.