Things to Consider When Labor Goes Long


small__8586461765.jpgFor most pregnant people, and especially in most first-time pregnancies, labor is like a marathon, not a sprint. And of course, this is just a comparison in terminology not in actual length of time, considering that even the slowest of marathoners can finish in under seven hours. But as in a marathon, it's important to prepare mentally for labor and birth as if it could be a long, slow haul. It's not uncommon for labor to be between 12 and 24 hours in length. And for some, birth can be 24-48 hours or longer. It is true that the laboring body is capable of amazing feats, with endurance and strength being the most awesome. It also is true that exceptionally long labors are exceptionally challenging. With added length of time also comes additional challenges and therefore it's important to take into consideration how your needs and support may look differently than it does for a shorter labor.

Sleep. For long labors, lack of sleep seems to be one of the most challenging effects to cope with and also the most difficult to remedy. It's impossible to truly rest or sleep long enough when the break between contractions is no more than 5-8 (or fewer) minutes apart. And yet, for longer labors, restorative rest is what the body needs. It's important during a long labor to fully rest (and even doze off) in between contractions, which means positioning yourself in a position that easily allows rest after a contraction, like sitting straight up in a bed or rocking chair, kneeling over the ledge of a tub (water also promotes relaxation), or sitting on an exercise ball pulled up next to a bed so you can rest your arms and head on the bed. If lack of sleep continues to be a significant issue, you can consider asking for an epidural. Even if an epidural was not originally in your plan, understand that a very long labor can be a game changer requiring that you adjust expectations and priorities. An epidural may be able to provide you with some much-needed rest and give a boost of energy to finish laboring and going into pushing. Of course, as with any intervention, it's important to understand the risks and side effects of an epidural, and weigh the trade offs. 

Nutrition. Marathon runners know the importance of fueling up before, during, and after their race. And that's for an event that only lasts 4-7 hours at the most! The same can be said for birth, especially when labor runs long. And because it's impossible to know in the beginning of your labor how long it will last, it's important to stay on top of nutrition and hydration. Despite many hospitals' policies of only eating clear fluids during labor (broth, jello, popsicle, water, ice, juice), the evidence shows that restrictions on eating during labor are not evidence based, and in fact, it's beneficial for women to eat during labor! A good mix of simple carbohydrates, protein, and sugars are best. Even small bites here and there (many laboring people don't feel like eating a lot) will go a long way to helping provide energy and stamina needed throughout labor. 

Support. Continuous labor support is important and helpful for anyone, whether labor is short, medium, or long. Continuous labor support is crucial for when labor goes long. Furthermore, it's very helpful to have two support persons in the case of longer labors (like your partner and a doula, for example). That way, if one support person needs to rest, the other can step in. Longer labors will require lots of hands-on support (like in the case of "back labor," which requires suggestions for position changes as well as additional comfort measures to relieve back pain) and encouragement. 

Causes. Sometimes, labor just takes a long time and there isn't a discernable "cause" for the length of time. Other times, however, there are reasons why labor is taking a long time. Baby's position, for example, can impact the length of labor. Babies who are in positions other than head down, facing down can cause erratic contractions and because their head is not applying firm, consistent pressure to the cervix, it can lengthen the process of dilation and baby descending into the pelvis. If malposition is suspected, call on help from a doula, a nurse, or your care provider to get into positions that encourage baby's rotation. SpinningBabies.com offers lots of helpful advice on the subject. Longer labors also can be caused by what is known as "emotional dystocia," which means that something emotionally charged may be holding you back from progressing in your labor, like prior trauma or fear. Guided meditation, time alone in your labor, finding a soothing mantra to repeat, or talking to someone about your fear in order to help let it go can help you release it and move on. 

Interventions. Interventions carry risks. Exceptionally long labors also can carry risks. There is a time and place for interventions, and in the case of long labor, interventions may be necessary and helpful. Interventions to consider during a long labor include epidural to provide rest, intrauterine pressure catheter to measure the strength of your contractions, and pitocin to enhance the strength of your contractions. Interventions should be personally evaluated with your care provider and support team. It's important to note that longer labors can place increased demands and stress on the body than what is generally experienced in labor. It's not that you're "weak" or "copping out," but rather you're listening to your body's needs and making choices that are appropriate for the situation at hand. 

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