# What constitutes a long labor?



## CI Mama (Apr 8, 2010)

I labored for 33 hours with my DD, and that felt like a long labor to me. But I've read stories here from women who've labored for far longer, which has made me curious about what is considered a "long" labor.

Is there a rule for determining that a labor has lasted long enough or is progressing slow enough to be considered "long"?

Is there a way to predict that a long labor is likely (either prior to labor starting and/or during the early hours of labor) and to prepare for its length? Are there things that can be done in late pregnancy to create better endurance in the event of a long labor?

Is there a natural way to speed up a labor that is progressing very, very slowly (or seemingly not at all)? Is there a rule for determining when interventions have more benefits than risks in terms of helping a slow/long labor progress?

Are c-sections more likely with long labors?

These are questions I wish I'd asked and found answers to prior to my labor. Any insights or stories are welcome.


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## GoBecGo (May 14, 2008)

I'm not a medical professional, but i'll try to answer from what i know.

Quote:


Originally Posted by *CI Mama* 
I labored for 33 hours with my DD, and that felt like a long labor to me. But I've read stories here from women who've labored for far longer, which has made me curious about what is considered a "long" labor.

I think it depends on the woman. 24 hours ACTIVE (beyond 4cm) labour is still pretty normal (according to Ina May Gaskin) for a first baby/labour, but second/subsequent babies are often shorter so that might be long for a 3rd timer. Equally if you count from the first niggle, rather than when you began active dilation (i do think 4cm is a bit arbitrary, but since some women get to 4 over 3 weeks of latent on-off labour and relatively few take the same weeks to get from 4-10 it seems an ok marker) that's likely going to be a much longer time. My #1 was 16 hours from waters breaking to birth, but only 3.5 from 4cm to birth, my #2 was 8hours from first painful contraction to birth, but only 61 minutes from regular, frequent contractions to birth. Part of the problem is about expectations - if EVERY woman expected a 36 hour labour and every care provider helped her to prepare and made sure she understood that would be within the realms of normal probably more women would be satisfied with their labours. As it is we (as a culture) fear birth, ask our women to labour where they are somewhat afraid or at least surrounded by the unfamiliar (place or people), and tend to hit the panic button as soon as anything deviates even slightly from textbook "normal" (which is often based on an average including labours which WERE intervened with)

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Is there a rule for determining that a labor has lasted long enough or is progressing slow enough to be considered "long"?
I'm not sure if there's a rule but as far as i can make out if one is in hospital it seems to depend on the time of day. A woman who's been labouring a long time who's Ob is about to go home is more likely to be dx failure to progress than a woman who only comes in, after the same time in labour, first thing in the morning. There are more emergency csections done for FTP during 9am and 4pm and on weekdays than at other times and on weekends. Sadly staffing DOES make a difference.

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Is there a way to predict that a long labor is likely (either prior to labor starting and/or during the early hours of labor) and to prepare for its length? Are there things that can be done in late pregnancy to create better endurance in the event of a long labor?
Some labours are a little longer -first babies, big babies, posterior babies, malpostioned babies. It's not always easy (and sometimes downright impossible) to know in advance if you're going to have a long labour. It's also not a clear rule, my friend has had 3 and her posterior baby, the middleweight in terms of size, was her fastest and easiest baby. I think the best things one can do for endurance is to surround ones-self with loving, supportive people who TRUST labour and BELIEVE you can do it, and to listen to your body when it comes to eating, resting, moving and sleeping.

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Is there a natural way to speed up a labor that is progressing very, very slowly (or seemingly not at all)? Is there a rule for determining when interventions have more benefits than risks in terms of helping a slow/long labor progress?
There are ways to speed up a slow labour, nipple stimulation, walking, lunges, some herbs and things. The question is do you WANT to speed the labour up - my last labour was on off all night long and i kept wishing i could speed it up, but when my DD was born she had a true knot in her cord, and i had felt her rolling from side to side a lot - i am pretty sure a faster labour would have killed her, she was doing it as safely as she could. Unfortunately there is often no way to determine before birth (and sometimes even afterwards) WHY a baby is driving a slow labour. The baby, to a massive extent, controls the speed of labour, and often times there is a reason for it being slow. I am positive SO many labours which are going slow and get augmented then end up with distressed baby and forceps/csection are because the baby wasn't ready to come down or have a faster labour, and when we force it we might be doing more damage than good. It's important to remember that the labour is a delicate dance between the baby's body and the mother's. If we interfere without cause we are likely to trip someone up - if the baby and the mama are doing ok then intervention isn't necessarily wise, however long the labour.

Equally there is no point forcing a woman to go on when she is exhausted and if the baby is becoming stressed then action is usually a wiser choice. Some women find an epidural after many hours of exhausting but slow-to-progress labour allows them a time to sleep and then can wake up refreshed and dilated and push their baby out. Some women find a labour which has been strong but is petering out again becomes strong, regular and effective after she sits down to a decent meal.

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Are c-sections more likely with long labors?

These are questions I wish I'd asked and found answers to prior to my labor. Any insights or stories are welcome.
Yes, but i think often because the long labour brings intervention even when the baby and mama are fine and it is THAT which leads to the cs.

I think a long slow labour CAN be normal, but might not be. Mama needs extra loving support and reassurance from her cheer squad, careful attention for her and the baby from her care-givers but not knee-jerk action, and a lot of personal courage. Courage is one of those things find we had enough of only in retrospect though!


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## Sharlla (Jul 14, 2005)

well all mine were 4 hours or less, omg i cant fathom being in labor for a day and a half. heres hoping your next one is faster
_Posted via Mobile Device_


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## CI Mama (Apr 8, 2010)

Quote:


Originally Posted by *GoBecGo* 
Some women find a labour which has been strong but is petering out again becomes strong, regular and effective after she sits down to a decent meal.


Thanks for your long, thoughtful response.

I do think lack of food was a big issue in my labor. In my case I kept trying to eat, but I threw everything up. It wasn't until I started the pitocen drip & they put an anti-nausea med in with it that the vomiting stopped. But then there was no way I could eat because the contractions were so strong, regular, and painful.

But I'm the kind of person who normally "grazes"--I rarely go for more than a few hours without food. And obviously I don't usually throw up repeatedly. So it was a real shock to my system to not be able to eat. It's one of those things that I wish I had been able to manage differently. The hospital provided a fully stocked snack room which they encouraged laboring moms & support people to eat from, and I brought my own food with me as well. But I couldn't keep any of it down, not even the popsicles.

Have others have other experiences? Has anyone out there had success eating a meal to "jump start" a labor that is flagging?


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## CI Mama (Apr 8, 2010)

Here are another couple questions that have come to mind, in case anyone has insight/ information:

Is there a correlation between being an older first-time mom & long labor?

Is there a correlation between a long conception process & long labor? (i.e. if it took you a long time to conceive, does that also make it more likely that you'll have a long labor)

Just fishing around for anything that might be a predictor.


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## GoBecGo (May 14, 2008)

Older first timers DO have longer labours, and younger ones often have shorter ones. A hospital midwife once told me "the 17 year olds, they come in, contract for 4 hours, push the baby out and go home". I think that correlates in veterinary fields too - i certainly know that older horses have a harder first labour than younger ones, which is a common consideration when a mare has had a longish successful athletic career and is now going to be bred - her genes are desirable but the process is more dangerous later in life, many owners opt for surrogacy in that situation. I do recall seeing a study on humans somewhere which suggested that in older mothers a long first labour had no correlation to length of second labour, when compared to younger women (so if you are 20 and had a long labour with #1 you are slightly more likely to have one with #2 than a woman who was 40 and had a long labour with #1 is with HER #2).

As far as i know, time taken to conceive doesn't correlate with labour difficulties unless, for example, a woman has a physical difference in her reproductive organs which would contribute to both. I certainly know a few mama's who had to go to IVF to get and stay pregnant and had very fast, straight-forward labours, and those who fell pregnant accidentally from one mistimed encounter with their husband and then had a very difficult delivery.

As regards eating, it's a pity they didn't offer you the anti-emetic before the pitocin, but hospitals usually regard eating in labour as unnecessary/unwise, despite studies showing it does no harm and sometimes improves outcomes, really it sounds like you did everything you could at the time. How many of those hours were you in hospital? It sounds like you had immense courage and fortitude to me. I have the opposite situation, a slow build up but a hurricane of an active labour and birth, *just* long enough that my emotions can recognise when i'm holding my baby that it IS mine. It's very difficult to prepare for the extremes at either end of normal i think.


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## ARG2003 (May 4, 2008)

I agree with GoBecGo, who has a plethora of information more than I would ever be able to give. Labors can all be different and I DO think the 4cm is a bit arbitrary since some women walk around at 4cm and for others it is quite some work to get there.

My labor with DS doesn't really fit anywhere. I started having twinges of crampy labor at 2pm. I started having painful, regular contractions at 5pm. As in- 4-5 minutes apart, lasting 1-2 minutes. I was sure I was in "active labor." Things stayed that way for about 42 hours. However, at the 42 hour mark, my cervix was only 1-2cm dilated. Was that not active labor? Was it stalled prodromal labor? Baby was born 6 hours later after half dose with pitocin (I didn't let them crank it up since my water broke just before they placed it). So, because I was having active labor like pain for 48 hours, I consider that to be a long labor, but since my cervix wasn't moving much was it?

I am preparing myself for a long labor again when this one comes in November. When I hear about women who had 4 hour labors I actually get nervous- like "I think I would feel like I got short-changed with such a short labor!" Not that I love the pain, but the journey is really something.

I was 32 years old when I delivered him and we got pregnant on our first month trying for him.


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## Detcb (Jun 15, 2010)

With your question about herbs- red raspberry leaf tea is supposed to shorten labor. I drank several cups every day from 30 weeks on. My husband calls me the poster child for rrl tea because I had one day of easy/early labor and then 2 1/2 hours of active/hard labor as a first timer.

It took two years and ivf for us to conceive, so I don't think there is a total correlation there.


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## kalamos23 (Apr 11, 2008)

I was 25 when I had DD. She was conceived first try (well, she was an oops IMO, but it was DH's first try lol).

I was walking around at 4cm at 80-100% dilated for almost 3 weeks before I actually started labor. I also had about 7 weeks of prodromal labor with her. When I did start, the first 28 hours of labor were not bad - it was definitely talk through the contractions. From hour 28-34, it got harder to labor. By hour 40 (with next to no sleep the previous night and this was about midnight), I was mentally exhausted.

I tried to eat, it kept coming up - I think at this point I was very close to transition (bear in mind, I started at 4cm, so I had gone 3ish cm in 40 hours!) By 3am (hour 43), I was losing it, so we asked for an epi. My water broke EVERYWHERE around hour 44, and that was about when I got the epu, I was having triple peaking contractions with no break inbetween at that point.

With the epi (I asked for a low dose - I could still feel my legs and walk) I went from 8cm-10 in 2 hours and was ready to push - she was out in 15 min at hour 48.

Next time around, I'm hoping for a slightly shorter labor, but at least this time I know what to expect and how to deal with it - everyone told me that I would go so fast since I was so dilated already but that was not the case.


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## gravida (Aug 19, 2010)

I was almost 40 hours from 4 cm to delivery. I consider that long. It sure felt like forever!







Everyone seems to count the start of their labor differently. If you start at the first twinge it will be a much bigger number (by that thinking I was in labor for 2 weeks) and other start at hard OMG contractions or somewhere in between. I think anything more than 24-30 hours of active labor is starting to get long.


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## Adamsmama (Oct 24, 2003)

My first labor was 30 hours. However, most of that was early labor. It took 5 hours to go from 3 to pushing...but they gave me pit at 5cm. My 2nd labor was 9 hours start to finish but I started out at a 3 (even before labor started) ... so 9 hours to go from 3 to pushing (no pitocin). My 3rd was 7 hours from 2cm to pushing but was a complete induction ... but I guess all of these are considered shorter labors?


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## kcparker (Apr 6, 2008)

Quote:


Originally Posted by *CI Mama* 
I labored for 33 hours with my DD, and that felt like a long labor to me. But I've read stories here from women who've labored for far longer, which has made me curious about what is considered a "long" labor.

I'd consider 33 hours of active labor long. But a labor with a long latent phase, wherein you labor for 4 hours a night for 4 nights, with breaks inbetween, then have 17 hours of labor that progresses and leads to birth, is longer from first contraction to baby born, equal in cumulative hours of contractions, but easier on the mama because she gets breaks to rest and eat. I would unscientifically define long as any length of time over 24 hours that pushes the mother waaaaay past the point at which she thought she could endure, but somehow she does.

Quote:

Is there a rule for determining that a labor has lasted long enough or is progressing slow enough to be considered "long"?
24 hours is not unreasonable, but my rule would be that when the mama is totally schwacked and tired beyond the point of endurance and _no progress, however incremental, has been made for a number of hours_ (like 3 or 4), or if baby is starting to sound like he's not tolerating labor well, then it's been long enough, and some sort of intervention is appropriate. But if everyone's energy is good and baby sounds like he's still happy, then there's no reason to put a time limit on it. Simply being slow is not truly a problem.

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Is there a way to predict that a long labor is likely (either prior to labor starting and/or during the early hours of labor) and to prepare for its length? Are there things that can be done in late pregnancy to create better endurance in the event of a long labor?
If you have a posterior baby, I think you can reasonably predict a longer, more energy-intensive labor for mama. Better to head that one off at the pass - get regular chiro. treatment, use good posture, do yoga and lots of cat-cow, don't use recliners, sit on the floor, use good posture (yes, I said it twice). Stay active all the way through the pregnancy, don't eat a crummy diet. Better to prepare for a short birth than to prepare to endure a long one.
That said, sometimes these things are out of our control. To prepare for a long birth, make sure you have a good place to labor - good means you have access to food, a resting area, a walking area, a sitting on a ball area, water (tub or shower), and a supportive team. Have distractions ready - tasks to do in early labor, music, a movie. Have comfort measures in place - rice sock, birth ball, massage tools, etc. Have coping skills - self-hypnosis, acupressure points, massage, dancing with partner - that you can use.
Stay active all the way through the pregnancy, don't eat a crummy diet.

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Is there a rule for determining when interventions have more benefits than risks in terms of helping a slow/long labor progress?
Labor progress can be slow for physical, physiological, or psychological/emotional reasons, and different interventions might help one but not another. If you can be proactive with the low-tech interventions early on, maybe the higher-tech ones will never be needed. Try to reposition the posterior baby sooner rather than hoping he turns on his own. Use nipple stimulation for increasing contraction strength before the mom is totally exhausted.
I think it's a delicate thing to know what that tipping point is for hospital-based interventions, but I would say that 1) a mother knows when she is _done_ and needs pain relief to cope so that pain doesn't veer into suffering and so she has the energy to go the distance in a long labor, and 2) if the baby's heart rate is starting to look bad, then interventions start looking like better options than doing nothing, especially if they are accompanied by maternal fever and exhaustion.

For physical/fit problems - If baby is in a poor position, can he be rotated or helped to move lower in the pelvis to apply better pressure to the cervix? Can counterpressure or hip squeezes open the pelvis a little extra? Can a knee-chest position allow baby to back out of the pelvic inlet a bit to reposition himself? Can a rebozo help jiggle him into a better position? Sometimes, there is true cephalo-pelvic disproportion, but it's fairly rare.
For physiological things - can nipple stimulation help get a better contraction pattern going? Can walking pick things up? If mama is tired, can she rest, eat, get some relief from pain? I think that it can be very appropriate to use pit. and/or request an epidural if mama is so exhausted that contractions are petering out, but baby needs to be born because of ruptured membranes for going on 24 hours. And back labor can be _so painful_ and _so exhausting_ for the mother that I think an epidural can be a godsend in some labors, the only thing that will allow her to rest enough to finish dilating.
I also think that sometimes the labor is slowed by mama's brain, and the low-tech end is to talk with her about what might be holding things up. Is there a way to help the mother feel safe or set aside her worries? Maybe she doesn't like her nurse, and just getting rid of that person will help. But if she has something like sexual abuse trauma and thinking about the birth is freaking her out, or if she has anxiety that she cannot get rid of, that can really keep the cervix closed down and hinder progress. I have seen an epidural help muscles relax when the mama is too scared or anxious and just. won't. let. go.

Quote:

Are c-sections more likely with long labors?
Only because the longer you labor the more time there is for baby to get stressed or for mom to get exhausted or for somebody to develop an infection, and if they are really long and unproductive, sometimes it's because there is some issue of fit that is just not resolving. But you CAN have a very long labor that results in a vaginal birth and a healthy mother and baby. It takes a lot of patience, lots of support for the mother, nourishment, encouragement, and determination.


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## CI Mama (Apr 8, 2010)

Quote:


Originally Posted by *ARG2003* 
My labor with DS doesn't really fit anywhere. I started having twinges of crampy labor at 2pm. I started having painful, regular contractions at 5pm. As in- 4-5 minutes apart, lasting 1-2 minutes. I was sure I was in "active labor." Things stayed that way for about 42 hours. However, at the 42 hour mark, my cervix was only 1-2cm dilated. Was that not active labor? Was it stalled prodromal labor? Baby was born 6 hours later after half dose with pitocin (I didn't let them crank it up since my water broke just before they placed it). So, because I was having active labor like pain for 48 hours, I consider that to be a long labor, but since my cervix wasn't moving much was it?

I had a similar experience. My water broke, I started having regular, strong contractions, including some pretty painful back labor, and I started vomiting. So I assumed (as did my doula & partner) that I was in "active" labor or at least very close. But after 18 hours, I was at 1.5 cm. I don't know what you call it when it feels like labor, but things aren't moving along, but it's a very frustrating and weird experience.

In a way, I wish I hadn't had the VE at 18 hours, because it was very discouraging to hear that I was in "early" labor after what felt like a lot of work!


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## CI Mama (Apr 8, 2010)

Quote:


Originally Posted by *GoBecGo* 
Older first timers DO have longer labours, and younger ones often have shorter ones. A hospital midwife once told me "the 17 year olds, they come in, contract for 4 hours, push the baby out and go home". I think that correlates in veterinary fields too - i certainly know that older horses have a harder first labour than younger ones, which is a common consideration when a mare has had a longish successful athletic career and is now going to be bred - her genes are desirable but the process is more dangerous later in life, many owners opt for surrogacy in that situation. I do recall seeing a study on humans somewhere which suggested that in older mothers a long first labour had no correlation to length of second labour, when compared to younger women (so if you are 20 and had a long labour with #1 you are slightly more likely to have one with #2 than a woman who was 40 and had a long labour with #1 is with HER #2).

Really interesting info. Do you recall more information about the study?

It makes intuitive sense to me that an older first-time mother (of any species) would have a longer labor, because generally speaking things slow down as we age. Though of course there is great variation in length of labors so one person's "slow" might still be quick compared to another person's "fast."


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## CI Mama (Apr 8, 2010)

Thanks to everyone who has responded. This has given me lots to think about and I appreciate the different perspectives.


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