What do we mean by a long labour? Whether a labour seems long or not depends on when we consider it to start and on how we experience the passing of time.
Expectations also have a large part to play - if we believe labour is 'taking too long', our anxiety can easily be transferred to the woman (and those who are supporting her). The old myth of 'never letting the sun set on labour twice' is a good case in point.
Labours wax and wane in intensity and progress: there is no 'right length' for a labour. One should be on the lookout for any clinical indications that might suggest fetal distress or other concerns but a longer labour need not, of itself, be seen as a problem.
When labour begins with ‘niggling'
Towards the end of pregnancy changes within the cervix often produce apparent symptoms of labour. You may well be familiar with the term 'niggling' to describe this. This 'spurious' labour nonetheless causes pain and distress and, if it persists for some time, tiredness as well.
If a woman arrives with 'niggling', this can make the whole experience seem much longer than it actually is, particularly if she then continues on into true labour without going back home in between. This can be avoided if a woman is primed during pregnancy with information about the possibility of spurious labour, and is able to access a midwife for advice and discussion if in doubt. This and the availability of assessment at home in labour reduces unnecessary admissions.
Once a woman with a 'niggling' labour has been admitted into a maternity unit, it is often tempting to induce labour, especially if there is capacity on the labour ward. By itself this is not a valid clinical indication for induction and this practice runs the risk of setting off a 'cascade of intervention'.
Altered images diminish the sense of time
During labour the ability to withdraw into oneself can alter a woman's perceptions of events. This can impact on the woman's ability to labour effectively and draw on her own resources and inner strength. However, things that draw a woman's attention back outside herself can interrupt this process, and it may be difficult for her to re-establish it.
Wherever possible, try to stop (or block out) unnecessary interruptions. Where it is necessary for you to carry out regular investigations, such as vaginal examinations, try to fit them around her rhythms. If she is 'withdrawn', try not to disturb her. Instead wait for her to come back out of herself, for instance to have a drink or empty her bladder. If she feels that you are in control of events happening in the outside, and that you will attend to whatever arises in the outer environment, this will make it much easier for her to withdraw. This can also alter the perception of time; creating an intangible sense of the length of time and sequence of events.
Tips and tricks
- Block out things that reinforce the sense of time - cover up the clocks, encourage her not to listen to the tv or radio (put on some music instead!), try to vary the intervals at which you do examinations.
- Monitor the condition of mother and baby very carefully - are they coping well? Do you feel that everything is progressing normally? Does anything concern you? What kind of feedback is she giving you - what is she saying, and what is her body language telling you.
- Can you identify any factors that may be prolonging labour? - has she been moved or disturbed, and has this slowed progress down? Does she need more privacy, or to feel that she is in a more secure environment? Are there others (health professionals or companions) whose presence is unsettling her?
Further reading
Royal College of Midwives (2001) Brown Study Series Number 1. Midwifery Clinical Practice: the first stage of labour. Royal College of Midwives Trust, London
Royal College of Midwives (2001) Brown Study Series Number 2. Midwifery Clinical Practice: the second stage of labour. Royal College of Midwives Trust, London
