Before a woman is about to deliver her baby, she will enter into
a process called labor. Labor refers to the period before delivery
when the mother experiences a series of continuous and progressive
contractions of the uterus. This causes the cervix to open (or
dilate) and to thin (or efface). These changes to the cervix allow
the baby to move through the birth canal, culminating in
Prolonged labor, also known as a failure to progress, occurs
when a woman’s labor lasts an atypical amount of time. Although
there are different definitions for what constitutes prolonged
labor, for first-time mothers, labor has historically been
considered prolonged if it lasts for approximately 20 hours or
more. For women who have given birth before, labor has historically
been considered prolonged if it lasts 14 hours or more. Prolonged
labor can be a warning sign that the mother or baby has been
injured, or an indication to change the delivery plan. Sometimes,
prolonged labor can cause stress on the baby, leading to serious
injuries. Thus, a healthcare provider needs to carefully monitor
the mother’s labor progress. When healthcare providers fail to
carefully monitor labor progress, or appreciate the risks of a
prolonged labor, they may commit medical malpractice.
What causes prolonged labor?
To understand prolonged labor, it is important to understand the
different stages of labor.
When a mother is in the first stage of labor, there are two
phases: the latent phase and the active phase. During the latent
phase, contractions typically become more frequent and stronger.
During this process, the cervix begins to open and thin out. The
second phase of the first stage of labor (also called the active
phase) occurs when the cervix opens from 4 to 7 centimeters. During
this time, contractions become longer, stronger, and more
During the second stage of labor, a woman’s cervix is
completely open and the mother typically begins to push the baby
for delivery. Typically, the second stage is shorter than the first
stage and may take between 30 minutes and three hours (depending on
a number of factors, including the number of prior
During the third and final stage of labor, a mother will deliver
the placenta (the organ that nourishes the baby during pregnancy).
This stage typically lasts just a few minutes.
Prolonged labor typically occurs in the first or second stage of
labor, and it can have a number of different causes. Generally
speaking, prolonged labor may occur during any phase of labor
- A mother’s contractions are weak
- The baby is in the incorrect position
- Certain medications act to delay labor
- The baby is too large to pass through the birth canal
- The mother’s pelvis is too small to allow the baby to be
- A mother is significantly stressed, exhausted, or anxious
In those situations, the healthcare providers need to recognize
the issue and treat the mother and baby appropriately so that the
baby can be delivered safely.
What should be done with prolonged labor?
When a woman’s labor is prolonged, the healthcare providers
should evaluate the potential causes and treat those in a timely
manner to protect the mother and baby. That may require that the
healthcare team move to prompt delivery to avoid harm to the mother
and baby. If the healthcare team fails to recognize a prolonged
labor, the mother or baby can suffer injuries.
Healthcare providers can use different methods to attempt to
expedite labor and delivery. Those include:
- Allowing the mother to rest for a period
- Encouraging movement like walking or changing positions
- Administering prostaglandin hormone or oxytocin (Pitocin) to
- Rupturing a woman’s membranes artificially (i.e., causing a
woman’s “water to break”)
If one or more of these interventions is attempted, the
healthcare team must monitor the mother and her baby continuously.
That way, the healthcare providers can make sure that the baby and
the mother remain safe. If there are any potential warning signs
that the baby or mother cannot tolerate ongoing labor, the
healthcare team must recognize that, and change the delivery plan
to expedite the baby’s delivery. That may require the
healthcare providers to proceed with a C-section to minimize the
risk of injury to the mother and baby. A medical provider’s
failure to monitor and assess delivery options at this stage could
constitute medical malpractice.
In situations where a mother is experiencing prolonged labor,
the healthcare providers need to monitor the mother and baby
carefully. It is important for the healthcare providers to monitor
the mother’s contractions (both in frequency and strength), the
mother’s vital signs, and the baby’s heart rate and
responses to labor. When prolonged labor persists despite
interventions, the health of the mother or baby may be at risk. A
failure to monitor when indicated can cause significant injuries to
the mother and her baby and may be evidence of medical
What injuries can be caused by a prolonged labor?
Prolonged labor increases the risk of certain injuries to the
- Postpartum hemorrhaging (or bleeding following childbirth)
- Obstetric trauma (injuries to the mother)
Prolonged labor also increases the risk of complications for the
- Admission to the neonatal intensive care unit (NICU)
- Low heart rates
- Low muscle tone
- Decreased reflexes
- Difficulty breathing
- Blue skin color
These are potential signs of decreased blood flow and oxygen to
the baby’s brain and vital organ systems. If these persist long
enough during a prolonged labor, a baby can suffer a brain injury
that can cause significant motor and cognitive delays or even
death. Click here to read more about birth injuries a baby
can suffer when medical providers commit medical malpractice.
One type of brain injury that a baby can suffer as a result of
prolonged labor is cerebral palsy, or CP, which is a neurological
condition caused by a lack of oxygen and blood flow to the brain.
If a child has CP, the child can develop impairments in motor
skills, muscle tone, and movement. The child may also have learning
disabilities, cognitive impairments, issues with speech, lung
issues, low bone density, and limited vision or hearing.
Unfortunately, while medical providers can offer treatments for CP,
there is no known cure for it. When a child has CP, the child may
have to live with lifelong complications.
Given the severity of this condition, it is crucial that the
delivery team monitor the mother and her baby during delivery
carefully so that, if there is a prolonged labor, the team can
intervene and deliver the baby timely and safely. If the healthcare
providers fail to recognize and intervene appropriately to protect
the health and safety of the mother and baby, and if they are
injured, the medical providers may have committed medical
When should I speak with a lawyer?
The delivery of a child should be a wonderful experience. But,
when a woman has a prolonged labor, and when she or her baby are
injured, it can be emotionally traumatizing, and the family may now
face significant medical costs associated with care and treatment
of the injured child.
If you think that the healthcare team that treated you and your
baby allowed your labor to progress too long, and if you think that
caused an injury to you or your child, you should consider speaking
to an attorney to determine whether you have a claim for medical
malpractice. An experienced medical malpractice lawyer that has
handled cases involving birth injuries can investigate your case,
work with experts to support your claim, and fight to get you and
your family answers and compensation to cover all expenses and
Originally Published 29 July 2022
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.