Definition

Pregnancy is something that many women long for. Of course, every mother hopes that the end of pregnancy is the birth of a baby. Almost all mothers desire a normal delivery process. However, childbirth is a difficult and exhausting process, and it can even be life-threatening if complications arise.

Vaginal Delivery Process

Normally, when labor is about to begin, a mother's uterus will contract intensely. Before labor begins, the initial contractions are mild and infrequent. As the delivery process approaches, the contractions become stronger and more frequent, to the point where they interfere with the mother's daily activities.

Contractions are generally felt in the lower back and lower abdomen. Most mothers describe contractions as a cramping sensation, similar to the feeling before having a bowel movement (defecation).

Contractions help push the baby out. They also help in the dilation of the cervix, allowing the baby to pass through.

For a first-time mother, normal labor typically takes about 12–18 hours. If the mother has previously given birth, the labor time is usually shorter, often taking half the normal duration.

Prolonged Labor

Prolonged labor occurs when the delivery process takes a long time. This extended duration complicates the labor. When labor lasts 20 hours or more for a first birth or 14 hours or more for mothers who have previously given birth, it is considered prolonged labor. If the mother is delivering twins or more, prolonged labor can occur if labor takes more than 16 hours. This can lead to fatigue and emotional exhaustion, though complications are rare.

Stages of Labor

• Stage 1: Stage 1 is divided into the latent phase and the active phase. The latent phase begins when the mother starts to experience contractions. The active phase starts when the cervix begins to dilate more rapidly, typically at around 4 cm dilation (4 cm open).
• Prolonged labor at this initial stage occurs if labor progresses for more than 8 hours without any transition from the latent phase to the active phase.
• In the active phase, prolonged labor occurs if labor continues for more than 12 hours without any progress to Stage 2.
• Stage 2: This stage begins when the cervix is fully dilated at 10 cm and ends with the birth of the baby. Normally, this stage lasts between 5 and 30 minutes. In cases of prolonged labor, this stage can last 2-3 hours for first-time mothers and 1-2 hours for mothers who have previously given birth.
• Stage 3: This stage starts from the birth of the baby until the placenta is delivered.

Causes

Prolonged labor is generally caused by three main factors, known as the 3Ps:

1. Passage: If the mother's pelvis is too small for the baby to pass through, it can cause prolonged labor.
2. Passenger: If the fetus weighs more than 4 kg or if the baby's size or head is too large to pass through the mother's pelvis, it can prolong the delivery process.
3. Power: Inadequate or weak contractions can lead to prolonged labor.

In addition to these main factors, a breech position (where the baby's buttocks or feet are positioned to come out first instead of the head) can also cause a longer labor.

Risk Factor

The risk factors for prolonged labor are divided into maternal factors and fetal or baby factors.

Maternal Factors

Maternal weight and the mother's ability to push the baby out. Excess maternal weight (obesity) increases the risk of higher baby weight and size. Obesity itself can also weaken the mother during labor. If the mother's weight is below normal (underweight), it can lead to a lack of necessary nutrients for the fetus and the mother during pregnancy.

Baby Factors

The risk factors from the fetal or baby side include the baby's weight, the size of the baby's head, and the position of the fetus during labor.

Symptoms

The main symptom of prolonged labor is when the delivery process takes more than 18 hours. Other symptoms may include:

• The pregnant mother may experience fatigue, dehydration, and dry mouth due to prolonged breathing through the mouth
• Pain in the back, lower back, and thighs due to prolonged pressure on the back
• Decreased labor pain due to muscle fatigue
• Increased blood pressure due to dehydration, fatigue, and stress
• The uterus becomes soft to the touch and does not fully relax between contractions

Diagnosis

The doctor will perform several examinations, especially during each stage of labor. The doctor will check:

• Signs and symptoms of the current condition
• Duration of labor
• Frequency and strength of contractions

Management

If labor is prolonged, the mother will be advised to rest. She may be given medication to reduce labor pain and help her feel more relaxed. The mother may also be advised to change positions to make herself more comfortable.

Additional treatments may be considered depending on the cause of prolonged labor. If the fetus is already in the birth canal, the doctor may use special tools called forceps or a vacuum device to help pull the baby out of the birth canal.

If the doctor determines that the mother needs stronger contractions, they may recommend induction, which involves administering the hormone oxytocin. This hormone can speed up and strengthen contractions. If labor does not progress after administering the medication, the mother may be advised to undergo a cesarean section.

Complications

Prolonged labor increases the likelihood of using assistive devices during labor, such as forceps or a vacuum, and may lead to a cesarean section.

Complications for the Baby

• Fetal distress is caused by a lack of oxygen.
• Intracranial hemorrhage, which occurs when the baby's head is held in the birth canal for too long.
• Sepsis, which is an infection that spreads throughout the body, entering through the ruptured amniotic sac.

In the long term, prolonged labor can lead to permanent complications for the baby, such as heart rhythm disturbances, seizures, cerebral palsy, and encephalopathy.

Complications for the Mother

The complications that can occur for the mother include:

• Infection
• Damage and tearing of the birth canal, such as cervical and vaginal tears
• Postpartum hemorrhage

Prevention

It is difficult to prevent prolonged labor, but mothers can avoid risk factors such as:

• Maintaining an ideal body weight.
• Consuming a balanced, nutritious diet to meet both the mother's and the baby's nutritional needs.
• Exercise moderately to maintain the mother's muscle strength to support the labor process.
• Consulting your doctor to diagnose the 3 Ps and monitor the health of the pregnant mother during the three trimesters.

When to See a Doctor?

Discuss with your obstetrician if the fetal position is abnormal. Additionally, regularly consult your doctor to monitor your pregnancy's health condition.

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