Prolonged and arrested labor

What is it?

Labor is described in stages.

The first stage runs from the start of labor until the cervix is fully open. It has a latent phase, which is slow and variable, and an active phase, which is faster.

The second stage runs from full dilation to the birth of the baby.

The third stage is the delivery of the placenta.

Progress is judged by cervical dilation, by how far down the baby has come, and by the position of the baby's head.

What arrest means

Arrest is not the same as slow. It means progress has stopped despite adequate contractions.

Guidance defines active phase arrest using dilation, membrane status and a defined period of adequate contractions without cervical change. It also addresses how long a second stage may continue, with different expectations for a first birth and for someone with an epidural. ¹

The change that matters most for families reading records is that guidance revised these definitions to allow more time than older standards did. A labor that would once have been called arrested may now be allowed to continue. ¹

The two risks

Calling arrest too early produces cesareans that were not needed, with all the risks a cesarean carries and consequences for future pregnancies. ¹

Letting labor continue when the baby is not tolerating it risks oxygen deprivation. ²

The fetal heart rate is what separates these. Duration alone does not tell you whether a baby is coping.

What does standard care look like?

Progress is assessed and documented, including dilation, station and position, with times.

Arrest is diagnosed using the defined criteria, not by the clock alone. ¹

Contractions are assessed for adequacy before arrest is diagnosed, since arrest means no progress despite adequate contractions. ¹

The fetal heart rate is monitored throughout, and it, rather than duration, is the measure of whether the baby is tolerating labor. ²

oxytocin is used appropriately where contractions are inadequate, with attention to tachysystole. ²

Operative vaginal birth is considered in the second stage where it is indicated and the prerequisites are met. ⁴

Infection is watched for during a long labor with ruptured membranes. ⁵

Hemorrhage is anticipated afterward, since a long labor is a risk factor. ³

What can go wrong?

Arrest diagnosed before the criteria were met, leading to a cesarean that guidance would not support. ¹

Labor allowed to continue with a concerning fetal heart rate. The duration is not the point. The tracing is. ²

Contractions not assessed before arrest was diagnosed. ¹

oxytocin pushed into tachysystole in an effort to make progress. ²

Position of the baby's head not identified, which matters because a head in an unfavorable position is a common cause of slow progress and it changes what should happen next. ⁴

Signs of infection during a long labor not acted on. ⁵

Operative vaginal birth attempted when the prerequisites were not met. ⁴

Hemorrhage not anticipated after a long labor. ³

Whether any of this amounts to a departure from the standard takes a physician expert reading the whole record.

Which injuries can follow?

For the baby

• HIE, where the baby was not tolerating labor and it continued. ⁶
• Caput succedaneum and cephalohematoma, from prolonged pressure. ⁷
• Injuries from instruments, where an assisted delivery follows a long second stage. ⁴
• Newborn infection, where membranes were ruptured for a long time. ⁵
• Facial nerve palsy, from prolonged pressure or from forceps. ⁷

For the mother

• Postpartum hemorrhage. ³
• Infection. ⁵
• Severe perineal tearing and pelvic floor injury. ⁸
• Uterine rupture, in an obstructed labor or with a uterine scar. ⁹

What does this look like in the records?

The labor flow sheet or partogram is the central document. It records dilation, station, position and contractions over time, with each entry timed.

What to look for

• The dilation at each examination and the time.
• The station, meaning how far down the baby was.
• The position of the baby's head.
• Contraction frequency and strength.
• The oxytocin rate at each point. ²
• The time arrest was diagnosed, and on what basis. ¹
• The fetal heart rate through the whole period. ²

Alongside

• Temperature readings, for infection. ⁵
• The time of rupture of membranes, and whether spontaneous or artificial.
• The delivery note and any operative note. ⁴
• The cord blood gas and Apgar score scores. ¹⁰
• The measured blood loss. ³

The records request builder names the labor flow sheet explicitly. ¹¹

What can you do this week?

1. Request the complete labor and delivery record for you and your baby. The records request builder writes the letters for you.
2. Write down what you remember while it is fresh, using the delivery timeline builder.
3. Read how to read your labor and delivery records before the records arrive.
4. Check the deadline to file in your state with the statute of limitations lookup.