The experience of each woman in each birth is unique and how it develops depends on whether it becomes an emotional or painful moment. However, despite the debates and research that have developed in recent years, the concept of what is normalized in labor is not yet unanimous.
This is stated by the World Health Organization (WHO), which indicates a “considerable increase in the application of various labor practices that allow the initiation, acceleration, termination, regulation or monitoring of the physiological process of this process”.
For the WHO, this growing medicalization “tends to weaken the ability of women to give birth and negatively affects their experience of childbirth .” But what happens when labor doesn’t progress? We consulted what the experts say about in which situations it is necessary to resort to techniques that help accelerate dilation during labor or when to allow it to pass naturally.
Reasons why labor is not progressing and what to do
The first phase of labor is dilation, which signals that the child is about to be born. For the birth to develop normally, the body of the pregnant woman and the baby are modified to allow the head of the fetus to pass through the maternal pelvis, the birth canal. Dilation is the degree of opening of the cervical os (the cervix), which goes from being closed to reaching 10 centimeters.
Dr. Sandra Ortega, gynecologist at the Vithas Castellón Hospital, points out that it is known that labor has begun, when:
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There is a neck dilation of at least 2 cm.
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A shortening of the cervix: it usually measures 4 cm and the contractions shorten it until it is completely erased, leaving a thin layer.
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Frequent, regular and continuous contractions (at least 2 every 10 minutes).
It is important to differentiate it from labor prodomes, which are previous signs that can start days before delivery and disappear after a few hours.
But there are times when dilation does not advance. The expert, a member of the Spanish Society of Gynecology and Obstetrics (SEGO), explains that “it is understood that labor does not progress when the neck does not dilate 1 cm per hour or the presentation of the baby does not rest on the neck.”
In these cases, the gynecologist adds that the possible cause must be looked for:
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It may be that the frequency and intensity of the contractions is not what you expected. This happens frequently when epidural anesthesia is applied. In this case, synthetic oxytocin is used to recover the contractions.
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It may be because the head position is not correct, so it is very effective for the woman to change position, standing on her side, sitting on a Swiss ball or fit ball, or getting on all fours so that the head attaches to the birth canal, which helps to dilate. Sitting on the ball, the force of gravity is greater and that facilitates the descent of the baby and the blood flow towards the placenta, in addition to controlling the pain of contractions in a natural way.
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The short umbilical cord or the circular cord around the neck are sometimes the cause why the baby’s head cannot descend. Fetal monitoring helps us by recording your heart rate and contractions to suspect the existence of circular cord tight to the neck.
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Hormones also play their part in this physiological process, as has happened throughout pregnancy. Specifically, oxytocin is responsible for the dilation of the cervix to begin. But this physiological process can be slowed down by another hormone, cortisol , which is released when the mother is nervous, and also by adrenaline that causes the woman to be more tense and increase the perception of pain. Relaxation techniques can help or, if possible in maternity, immersion in hot water, which is recommended when the woman has reached a dilation of at least 5 cm.
Cesarean section will be the option , the necessary physiological time has been waited, and the possible causes of stalled labor have been corrected. But even then the dilation stops between 3 and 8 cm for at least 2 hours, and even if oxytocin has been administered or the bag has ruptured, the conditions do not change.
What the WHO says
The World Health Organization distinguishes two phases in the dilation period in its ‘Recommendations for care during childbirth, for a positive birth experience’:
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Latent phase: characterized by painful uterine contractions and variable changes of the cervix, even with some effacement and slower progression of dilation up to 5 cm for the first labor. There is no standard duration and this can vary from woman to woman. It is measured by vaginal examination.
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Active: when uterine contractions are painful and regular with a significant degree of effacement and faster dilation of the cervix from 5 cm to full dilation. Generally, it does not last more than 12 hours in deliveries to first-time mothers and 10 in subsequent ones.
WHO notes that “for pregnant women with onset of spontaneous labor, a rate of dilation of the cervix less than 1 cm per hour should not be a routine indicator for obstetric intervention.” It is not used to identify women who are at risk for adverse childbirth outcomes. In fact, some studies suggest that it is slower.
Labor may not naturally accelerate until a cervical dilation threshold of 5 cm is reached. Therefore, the use of medical interventions to accelerate labor and delivery (such as oxytocin stimulation or caesarean section) before this threshold is not recommended , as long as the good conditions of the fetus and the mother are ensured.
In addition, it does not recommend applying these cares for the prevention of delayed labor :
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Amniotomy or manual rupture of the amniotic fluid sac with administration of oxytocin.
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The use of oxytocin for the prevention of delayed labor in women undergoing epidural anesthesia.
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The use of antispasmodics or intravenous fluids.
Photos | iStock
In Babies and More | These are ten centimeters of dilation: this is how the cervix adapts so that the baby can be born, The five phases of labor: what will happen at each moment explained step by step
