5 strategies for dealing with a long labour

You can finish a marathon in under five hours if you train like a pro, but all the prenatal prep in the world won’t help you deliver a baby in record time. And if it’s your first, it’s likely to take even longer than you assume. “A first-time mom can expect to labour for 14 to 20 hours,” says Yolanda Kirkham, an OB/GYN at Women’s College Hospital and St. Joseph’s Health Centre in Toronto.

Shelley Gordon spent nearly 24 hours in active labour with her first child. The Hamilton, Ont., yoga teacher’s pregnancy was already in overtime—she was two weeks past her due date and had to be induced, which can itself contribute to a longer delivery. Once it began, Gordon’s labour was a series of stops and starts. She would dilate to 10 centimetres and then push and push—for almost an hour—but still, no baby. Over 24 hours, she went through the push-stop-and-rest cycle three times. Her OB/GYN then tried using forceps, to no avail. At this point, it was too risky to continue labouring, so a few hours later, she finally delivered her son, Wallace, via C-section.

The best way to prepare for the unpredictability of labour is to understand the stages and put together a support team to get you through it, says Shannon Arntfield, a faculty member in the department of obstetrics and gynaecology at Western University in London, Ont.

The four stages of labour The initial stage consists of two phases. The first, known as the latent phase or early labour, occurs before your cervix is four centimetres dilated and is characterized by regular, mild contractions. “How long it will last is extremely variable,” says Arnt­field. You could spend up to 48 hours in this phase, which can be intense and draining but isn’t generally cause for concern.

The second phase of stage one is active labour, which begins once your cervix dilates to four centimetres. Contractions intensify as you continue to dilate fully to 10 centimetres. This phase can stall before you finally hit stage two—full dilation—and stage three—delivering the baby. Stage four is the first hour postpartum.

There are two red flags that signal potential obstacles to a speedy delivery, Arntfield says: “When there’s no cervical change for more than four hours after a woman is more than four centimetres dilated, or if the baby hasn’t been delivered after approximately two hours of pushing.” That’s when you know you might be in for the long haul.

Why labour goes long Childbirth can stretch out for three main reasons. Arntfield refers to them as the three Ps: power, passenger and passageway. Power refers to the strength of the contractions; the passenger is the baby and its general size, shape and position; and passageway is the bony pelvis. Weak contractions are the easiest variable to diagnose and correct, says Kirkham. “We can help augment contractions by providing oxytocin to try to strengthen contractions and help labour progress.”

If contractions increase and there is little progress, then it’s likely that one of the other Ps is at play. “It’s often possible to know whether the ‘passenger’ is an issue, because there are clinical signs that a baby is face up, for example,” says Arntfield. In that case, the OB/GYN might need to turn the baby manually or use forceps.

It’s not always clear that the passageway is the troublesome factor until all of the standard interventions to support a vaginal delivery have failed. In these cases, a C-section is the most likely outcome.

Even if it’s going to be a bit of a marathon after all, there are steps you can take to get you through to the finish line.

1. Take a team approach It doesn’t matter if it’s your partner, mother, best friend or doula, having a good, supportive labour partner is crucial in making it a positive experience—and so is having trust between you and your doctor or midwife. “There is strong evidence that women who have a good relationship with their care team and good, supportive partners while labouring do better,” Arnt­field says.

2. Move around When the pain is intense, move your body. Walk around, have a shower, sit in a bath or use a birthing ball to find some relief. Ask your partner to gently massage your back.

3. Ask for meds If you have reached your breaking point, ask for pain-relief drugs, such as Tylenol, morphine, nitrous oxide or an epidural.

4. Breathe The noisy breathing techniques you may have learned in prenatal classes really can help relieve the intensity of the moment by giving you something else to focus on.

5. Remember the goal What kept Gordon going was the idea of holding her baby in her arms. “Nothing else comforted me at that point,” she laughs. Not her husband, not her yoga breathing, not the music she brought along, not the epidural—nothing but reminding herself of the reason for all the pain...all nine pounds, 12 ounces of him.

A version of this article appeared in our November 2016 issue, titled "A long day's night," pg. 49.

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