DEFINITION: The labor is said to be prolonged when the combined duration of the first and second stage is more than the arbitrary time limit of 18 hours. The prolongation may be due to protracted cervical dilatation in the first stage and/or inadequate descent of the presenting part during the first or second stage of labor. Labor is considered prolonged when the cervical dilatation rate is less than 1 cm/h and descent of the presenting part is less than 1 cm/h for a period of minimum 4 hours' observation. Prolonged labor is not synonymous with inefficient uterine contraction. Inefficient uterine contraction can be a cause of prolonged labor, but labor may also be prolonged due to pelvic or fetal factor.
PROLONGED LATENT PHASE:
Latent phase is the preparatory phase of the uterus and the cervix before the actual onset of labor.
Mean duration of latent phase is about 8 hours in a primi and 4 hours in a multi. Whether prolonged latent phase has got any adverse effect on the mother or on the fetus, it is not clearly known. A latent phase that exceeds 20 hours in primigravidae or 14 hours in multiparae is abnormal. The causes include:
1) Unripe cervix,
2) Malposition and Mal presentation,
3) Cephalopelvic disproportion,
4) Premature rupture of the membranes,
5) Induction of labor and 6)early onset of regional anesthetic.
Prolonged latent phase may be worrisome to the patient but does not endanger the mother or fetus.
Management: Expectant management is usually done unless there is any indication (for the fetus or the mother) for expediting the delivery. Rest and analgesic are usually given. When augmentation is decided, medical methods are preferred. Amniotomy is usually avoided. Prolonged latent phase is not an indication for cesarean delivery.
CAUSES OF PROLONGED LABOR: Any one or combination of the factors in labor could be responsible.
First stage: Failure to dilate the cervix is due to:
- -Fault in power: Abnormal uterine contraction such as uterine inertia (common) or incoordinate uterine contraction
- -Fault in the passage: Contracted pelvis, cervical dystocia, pelvic tumor or even full bladder
- -Fault in the passenger: Malposition (OP) and malpresentation (face, brow), congenital anomaliesof the fetus (hydrocephalus).
HOMOEOPATHIC MEDICINES FOR MANAGING PROLONGED LABOUR: -
1) Cal phos:- this remedy can help to strengthen a woman who tends toward easy tiredness,poor digestion, cold hands and feet, and poor absorption of nutrients. A person who needs cal phos is often irritable because of tiredness, and may long for a travel or a change of circumstances.
2) Caulophyllum:- this remedy may be helpful in women with weak muscle tone in the uterus. A history of irregular periods, slow and difficult labour with previous deliveries, or weakness of the cervix may bring this remedy to mind. She typically feels nervous, shaky, and trembling.
3) Carbo Veg:- this remedy can be helpful to a woman who feels weak and faints during pregnancy, with poor circulation, a general feeling of coldness, and a craving for fresh or moving air. She may also have frequent digestive upsets with burning pain and a tendency to belch.
4) Actaea racemosa:- this remedy can be helpful to women who are nervous and talkative,with a tendency to feel fearful and gloomy during pregnancy. They may become overagitated and a dear of miscarriage prevails.
5) Ferrum phos:- this remedy can be helpful for nervous sensitive women who feel weak or tired with easy flushing of face and a tendency towards anaemia. A woman who needs this remedy often has a slender build and may develop frequent neck and shoulder stiffness.