Before a woman is about to deliver her baby, she will enter into a process called labor. Labor refers to the period before delivery when the mother experiences a series of continuous and progressive contractions of the uterus. This causes the cervix to open (or dilate) and to thin (or efface). These changes to the cervix allow the baby to move through the birth canal, culminating in delivery.
Prolonged labor, also known as a failure to progress, occurs when a woman’s labor lasts an atypical amount of time. Although there are different definitions for what constitutes prolonged labor, for first-time mothers, labor has historically been considered prolonged if it lasts for approximately 20 hours or more. For women who have given birth before, labor has historically been considered prolonged if it lasts 14 hours or more. Prolonged labor can be a warning sign that the mother or baby has been injured, or an indication to change the delivery plan. Sometimes, prolonged labor can cause stress on the baby, leading to serious injuries. Thus, a healthcare provider needs to carefully monitor the mother’s labor progress. When healthcare providers fail to carefully monitor labor progress, or appreciate the risks of a prolonged labor, they may commit medical malpractice.
What causes prolonged labor?
To understand prolonged labor, it is important to understand the different stages of labor.
When a mother is in the first stage of labor, there are two phases: the latent phase and the active phase. During the latent phase, contractions typically become more frequent and stronger. During this process, the cervix begins to open and thin out. The second phase of the first stage of labor (also called the active phase) occurs when the cervix opens from 4 to 7 centimeters. During this time, contractions become longer, stronger, and more frequent.
During the second stage of labor, a woman’s cervix is completely open and the mother typically begins to push the baby for delivery. Typically, the second stage is shorter than the first stage and may take between 30 minutes and three hours (depending on a number of factors, including the number of prior pregnancies).
During the third and final stage of labor, a mother will deliver the placenta (the organ that nourishes the baby during pregnancy). This stage typically lasts just a few minutes.
Prolonged labor typically occurs in the first or second stage of labor, and it can have a number of different causes. Generally speaking, prolonged labor may occur during any phase of labor when:
- A mother’s contractions are weak
- The baby is in the incorrect position
- Certain medications act to delay labor
- The baby is too large to pass through the birth canal
- The mother’s pelvis is too small to allow the baby to be delivered
- A mother is significantly stressed, exhausted, or anxious
In those situations, the healthcare providers need to recognize the issue and treat the mother and baby appropriately so that the baby can be delivered safely.
What should be done with prolonged labor?
When a woman’s labor is prolonged, the healthcare providers should evaluate the potential causes and treat those in a timely manner to protect the mother and baby. That may require that the healthcare team move to prompt delivery to avoid harm to the mother and baby. If the healthcare team fails to recognize a prolonged labor, the mother or baby can suffer injuries.
Healthcare providers can use different methods to attempt to expedite labor and delivery. Those include:
- Allowing the mother to rest for a period
- Encouraging movement like walking or changing positions
- Administering prostaglandin hormone or oxytocin (Pitocin) to stimulate contractions
- Rupturing a woman’s membranes artificially (i.e., causing a woman’s “water to break”)
If one or more of these interventions is attempted, the healthcare team must monitor the mother and her baby continuously. That way, the healthcare providers can make sure that the baby and the mother remain safe. If there are any potential warning signs that the baby or mother cannot tolerate ongoing labor, the healthcare team must recognize that, and change the delivery plan to expedite the baby’s delivery. That may require the healthcare providers to proceed with a C-section to minimize the risk of injury to the mother and baby. A medical provider’s failure to monitor and assess delivery options at this stage could constitute medical malpractice.
In situations where a mother is experiencing prolonged labor, the healthcare providers need to monitor the mother and baby carefully. It is important for the healthcare providers to monitor the mother’s contractions (both in frequency and strength), the mother’s vital signs, and the baby’s heart rate and responses to labor. When prolonged labor persists despite interventions, the health of the mother or baby may be at risk. A failure to monitor when indicated can cause significant injuries to the mother and her baby and may be evidence of medical malpractice.
What injuries can be caused by a prolonged labor?
Prolonged labor increases the risk of certain injuries to the mother, including:
- Postpartum hemorrhaging (or bleeding following childbirth)
- Obstetric trauma (injuries to the mother)
Prolonged labor also increases the risk of complications for the baby, including:
- Admission to the neonatal intensive care unit (NICU)
- Low heart rates
- Low muscle tone
- Decreased reflexes
- Difficulty breathing
- Blue skin color
These are potential signs of decreased blood flow and oxygen to the baby’s brain and vital organ systems. If these persist long enough during a prolonged labor, a baby can suffer a brain injury that can cause significant motor and cognitive delays or even death. Click here to read more about birth injuries a baby can suffer when medical providers commit medical malpractice.
One type of brain injury that a baby can suffer as a result of prolonged labor is cerebral palsy, or CP, which is a neurological condition caused by a lack of oxygen and blood flow to the brain. If a child has CP, the child can develop impairments in motor skills, muscle tone, and movement. The child may also have learning disabilities, cognitive impairments, issues with speech, lung issues, low bone density, and limited vision or hearing. Unfortunately, while medical providers can offer treatments for CP, there is no known cure for it. When a child has CP, the child may have to live with lifelong complications.
Given the severity of this condition, it is crucial that the delivery team monitor the mother and her baby during delivery carefully so that, if there is a prolonged labor, the team can intervene and deliver the baby timely and safely. If the healthcare providers fail to recognize and intervene appropriately to protect the health and safety of the mother and baby, and if they are injured, the medical providers may have committed medical malpractice.
When should I speak with a lawyer?
The delivery of a child should be a wonderful experience. But, when a woman has a prolonged labor, and when she or her baby are injured, it can be emotionally traumatizing, and the family may now face significant medical costs associated with care and treatment of the injured child.
If you think that the healthcare team that treated you and your baby allowed your labor to progress too long, and if you think that caused an injury to you or your child, you should consider speaking to an attorney to determine whether you have a claim for medical malpractice. An experienced medical malpractice lawyer that has handled cases involving birth injuries can investigate your case, work with experts to support your claim, and fight to get you and your family answers and compensation to cover all expenses and costs.
Why Morris James?
The medical malpractice attorneys at Morris James have handled many complex birth injury cases, including those involving prolonged labor. Before advocating for the injured, our attorneys defended healthcare providers who delivered babies so we know how those medical providers defend their care when a baby is injured after a prolonged labor. Our attorneys can anticipate the tactics used to minimize compensation to injured victims and fight for our clients to obtain answers and the full compensation to which they are entitled.
At Morris James, our attorneys have been standing up for victims since we opened our doors in 1932. If you have questions about a birth injury, you may find answers in our birth injury FAQs, or you can contact us online or call us at 302.655.2599 to learn more.