When labor slows significantly or stops progressing, it is often called stalled labor or a failure to progress. This is a common occurrence in childbirth that is usually manageable. Stalled labor is not typically an immediate danger to the birthing person or the baby, allowing time for careful consideration of next steps. The diagnosis generally applies once a person is in the active phase, traditionally defined as reaching 6 centimeters of cervical dilation. Understanding the reasons behind the slowdown is the first step toward finding a solution.
Understanding Why Labor Progression Slows
The progression of labor is a complex interaction influenced by multiple factors, commonly categorized as the three “P’s”: Power, Passage, and Passenger. A problem with any one of these can cause labor to slow or stop. Identifying the specific “P” that is causing the delay helps guide the strategy for intervention.
Power
Power refers to the effectiveness of uterine contractions, which are the driving force of labor. Contractions may become insufficient in frequency, intensity, or duration, meaning they are not strong enough to cause the cervix to dilate or the baby to descend. Natural oxytocin levels, which stimulate contractions, can be negatively affected by maternal exhaustion, dehydration, or high levels of stress and fear.
Passenger
Passenger relates to the baby, specifically their size, presentation, and position within the pelvis. While size can be a factor, a more frequent cause of stalling is the baby’s position, such as occiput posterior (OP), often called “sunny-side up.” When the baby’s head is not optimally tucked and rotated, it leads to inefficient contractions and a lack of descent.
Passage
Passage involves the birth canal, including the bony pelvis and the soft tissues of the lower uterus, cervix, vagina, and perineum. Although the bony pelvis is generally flexible, tension in the soft tissues or a lack of optimal pelvic mobility can create resistance. An unbalanced pelvic position can restrict the space needed for the baby to rotate and descend efficiently, leading to a mechanical stall.
Immediate Non-Medical Strategies for Restarting Labor
When labor begins to slow, the first approach often involves non-medical strategies aimed at optimizing the body’s natural processes and correcting the baby’s position. These techniques focus on movement and relaxation to address issues related to Power and Passenger.
Therapeutic movement, such as walking, slow dancing, or using a birth ball, is effective because it uses gravity and encourages subtle shifts in the pelvic joints. Rocking the hips or performing figure-eight motions can help the baby’s head apply more even pressure to the cervix, encouraging dilation. These movements also help relieve tension in the soft tissues of the pelvis, allowing for more space.
Positional changes are important for encouraging the baby to rotate out of a less favorable position, such as occiput posterior. Techniques like the side-lying release, the abdominal lift and tuck, or using a peanut ball between the knees, open up specific areas of the pelvis. Spending time in hands-and-knees positions also uses gravity to relieve back pressure and give the baby more room to turn.
Emotional support and relaxation techniques address the Power issue by managing the body’s hormonal environment. High stress and fear cause the release of catecholamines, which inhibit the production of oxytocin, the hormone responsible for strong contractions. Creating a sense of safety through dimming lights, playing soft music, using massage, or taking a warm shower or bath can be beneficial.
Adequate hydration and nourishment also support the Power needed for continued contractions. Labor is physically demanding, and exhaustion coupled with low blood sugar can cause contractions to fizzle out. A short period of rest, sometimes combined with a light meal or snack, can restore energy reserves and allow the uterus to resume strong, coordinated contractions.
Clinical Interventions When Labor Stalls
If non-medical strategies fail and arrested labor is confirmed, medical interventions are the next step under careful supervision. Active phase arrest in the first stage is typically diagnosed when the cervix is 6 centimeters or more dilated, the membranes are ruptured, and there has been no change in dilation after four hours of adequate contractions or six hours with insufficient contractions.
Synthetic Oxytocin (Pitocin)
The use of synthetic oxytocin, often called Pitocin, is a common intervention administered intravenously to augment contractions. Pitocin is a pharmacological mimic of the body’s natural hormone. It is started at a low dose and gradually increased, or titrated, to achieve strong, regular contractions. The goal is to stimulate approximately four to five contractions every ten minutes, which is considered adequate to drive cervical change and fetal descent.
Amniotomy
Another procedure is an amniotomy, or artificially rupturing the membranes, often called “breaking the water.” This is performed using a specialized tool to create a small opening in the amniotic sac. Releasing the amniotic fluid allows the baby’s head to press more directly on the cervix. This mechanically stimulates the release of natural prostaglandins and oxytocin, often intensifying contractions.
Both Pitocin and amniotomy require continuous electronic fetal monitoring to assess the baby’s response to stronger contractions. Uterine tachysystole (too many contractions in a short period) is a risk of augmentation that can reduce the oxygen supply to the baby. If these interventions fail to achieve progress after established time limits, the medical team must consider the next appropriate step for a safe delivery.
If the first stage remains arrested despite augmentation, or if the second stage (pushing phase) is prolonged, the care team evaluates final delivery options. If the baby’s head is low and the issue is pushing efficiency, an assisted vaginal delivery using a vacuum device or forceps may be used. If the stall is due to persistent malposition, disproportion between the baby and the pelvis, or signs of fetal distress, a Cesarean section becomes the necessary pathway for a safe birth.