a doula combining Science and spirituality, research and Intuition..

Prolonged latent labour

A recent article appeared on my fb feed, ‘My clients body is broken’ (http://tucsondoulas.com/clients-body-broken/)
There is much I agree with what Angela has said, rest, relaxation, reassurance should be the first things any doula suggests when labour is slow to start.
We have all seen eager first time mum’s, so excited that labour has started that they stay up all night pacing with a tens machine when contractions are still very irregular or far apart. If you add in a second night like that, you can end up with an exhausted mother, especially if she hasn’t eaten much with all the butterflies, desperate to go into hospital and get them to do something to get her baby to come out. This is not an ideal recipe for active labour!
This got me thinking about one of the claims that was made in Angela’s article:

“Prodromal labor is not a problem that needs to be fixed. It is normal!”

How many women experience a latent phase of labour and how long does this usually go on for before active labour begins?

Many signs can proceed the start of labour (e.g. discharge, bloody show, nausea, back ache) but the latent phase of labor is seen to commence with the onset of regular contractions and ends when the rate of cervical dilatation begins to accelerate (active phase) . Contractions in the latent phase of labour can be far apart or can get closer together when women are active and slow down when resting.
Greulich (2007) stated that approximately 5% to 6.5% of women are given the diagnosis of prolonged latent phase of labor.(Using Friedman’s original definition of prolonged latent phase as greater than or equal to 20 hours in nulliparas and 14 hours in multiparas.) and a study by Chelmow (1993) that used a definition of >12 hours for women having their first baby and >6h for women having a subsequent baby) found an overall prevalence of 6.5%

Women with a prolonged latent phase that cannot rest due to frequent or painful contractions that disrupt sleep can become exhausted. Women can end up wanting to transfer from planned homebirth for analgesia purely to get some sleep and I have seen women falling asleep in birth pools in between contractions in the second stage, only to be woken in a panic a couple of minutes later, forgetting where she is and what she is doing.

Recent research has found that length of latent phase duration as well as food intake and the amount of rest and sleep during the preceding 24 hours are independent predictors of [active] labor duration (Dencker 2010)
Chelmow also looked at outcomes after prolonged latent phase of labour and found women with prolonged latent phase labor are at higher risk of cesarean delivery and longer hospital stay and their newborns are more likely to require neonatal intensive care unit admission, have meconium at birth, and have depressed Apgar Scores.

What happens when women go to hospital?

Early admission to hospital (in latent phase) has long been recognised as a risk factor for subsequent labor abnormality and intervention (Bailit 2005) including prolonged labour, more need for analgesia, increased rate of caesarean section, increased PPH and postpartum hospital stay (Janna 2013).
Like the chicken and the egg it is difficult to interpret whether those interventions are due to complications leading from prolonged early labour or from extra intervention due to the early admission. For some more discussion on this on the ‘Midwives thinking blog’ https://midwifethinking.com/2013/11/13/early-labour-and-mixed-messages/

In a another recent study women indicating that they had been in labour for 24 hours or longer at the time of hospital admission were at elevated risk for caesarean birth (Janssen 2014)
Many women are turned away from hospital (either to try to reduce the risk of unnecessary intervention or because the unit does not have room or staff able to care for women who are not in active labour. This can be disheartening for women who are in considerable pain and distress. Hopefully those with a doula will have had more support in the latent phase. However I have read of doulas that refuse to see their clients in early labour, partly so as to reduce the number of people ‘watching and waiting’ (and the subsequent pressure on women to perform by going into active labour (when this is out of their control) and partly to conserve their own energy in what might be a long labour.
This is not much help to women who have been in pain for a considerable time, feeling unsupported by a midwifery service who tell them they are not really in labour and to go home and take a painkiller, and a doula that will not support them in early labour.

Summary
  • A period of time where women are unsure if labor has started is normal and may include a range of signs
  • A period of latent phase of labour where contractions have started but are far apart or infrequent is common
  • During this latent phase of labour women have better outcomes if they rest, sleep and eat normally and avoid admission to hospital (unless they have other risk factors or worries about their babies welfare like reduced movements)
  • Women that experience prolonged latent phases, especially with painful contractions that prevent sleep and food intake may need additional support and may be at greater risk for longer labours and more intervention during the birth
  • Prolonged latent phase may be associated with malposition
  • Women with prolonged latent phases may need additional support from their birth partners, including a greater range of comfort measures and support to aid fetal rotation so that active labour may begin

Maybe helping mothers move in ways that aid fetal rotation and so reduce the length of time in a prolonged latent phase is a comfort measure?

I think so
Selina-7844
References
Greulich, B. and Tarrant, B. (2007), The Latent Phase of Labor: Diagnosis and Management. Journal of Midwifery & Women’s Health, 52: 190–198. doi: 10.1016/j.jmwh.2006.12.007
Chelmow, D, Kilpatrick, SJ, Laros, RK Jr. Maternal and neonatal outcomes after prolonged latent phase. Obstet Gynecol 1993; 81:486.
Bailit, J. L., Dierker, L., Blanchard, M. H., & Mercer, B. M. (2005). Outcomes of women presenting in active versus latent phase of spontaneous labor. Obstetrics & Gynecology, 105(1), 77-79.
DENCKER, A., BERG, M., BERGQVIST, L. and LILJA, H. (2010), Identification of latent phase factors associated with active labor duration in low-risk nulliparous women with spontaneous contractions. Acta Obstetricia et Gynecologica Scandinavica, 89: 1034–1039. doi: 10.3109/00016349.2010.499446
Friedman EA. Labor: Clinical evaluation and management. New York: Appleton-Century-Crofts, 1967.
Janna, J. R., & Chowdhury, S. B. (2013). Impact of timing of admission in labour on subsequent outcome. Community Based Medical Journal, 2(1), 21-28.
Janssen, P. A., & Weissinger, S. (2014). Women’s perception of pre-hospital labour duration and obstetrical outcomes; a prospective cohort study. BMC Pregnancy and Childbirth, 14(1), 182

 

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3 responses

  1. Pingback: Does baby’s position matter in pregnancy and can we do anything about it? | magicalbirth

  2. Pingback: Vaginal exams in labour (*Trigger warning) | magicalbirth

  3. Pingback: Painful birth? | magicalbirth

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