Prolonged or slow labour: what counts as delay and what can help

The NHS says you may feel irregular contractions for many hours, or even days, before established labour begins. NICE defines the latent first stage as a period, not necessarily continuous, with contractions and some cervical change up to 4 cm, and the established first stage as regular contractions with progressive dilatation from 4 cm. Tommy's adds that the latent stage is not always smooth: contractions can seem to get regular and then slow or stop for a while, and it is usually the longest part of labour.

Once labour is established the NHS gives 8 to 18 hours in a first pregnancy and 5 to 12 hours in a second or third to reach full dilatation, and Tommy's says the established phase in a first labour tends to be around 8 hours and rarely longer than 18. These are ranges rather than deadlines, and your own progress is judged by your own pattern.

Many people think labour has stalled during the latent phase. Tommy's says that in healthy full-term pregnancies your midwife may suggest you stay at home, and that some evidence suggests staying at home until established labour means fewer interventions, though home is not best for everyone. NICE advises that breathing exercises, a shower or bath and massage may reduce pain in the latent stage. Tommy's suggests moving about by day, resting at night, drinking water and having small snacks.

The NHS says to call your midwife or maternity unit for guidance if you think you are in labour, contractions are coming every 5 minutes or more often, or you are worried about anything. Call urgently if your waters break, you have vaginal bleeding, your baby is moving less than usual, or you are under 37 weeks and think you might be in labour.

NICE says that when delay in established first stage is suspected, the team should consider parity, cervical dilatation and its rate of change, the strength and pattern of contractions, and the station and position of the baby's head. It lists cervical dilatation of less than 2 cm in 4 hours in first labours as one feature (with descent, rotation of the head and contractions also considered), and a different threshold, less than 2 cm in 4 hours or a slowing of progress, in later labours. A repeat vaginal examination is advised 2 hours later, and delay is diagnosed if progress is less than 1 cm. You should be offered support, hydration and effective pain relief, and the findings and options should be discussed with you.

The NHS and Tommy's both describe two main ways of speeding things up. Breaking the waters (amniotomy) is often enough to make contractions stronger and more regular; NICE says it will shorten labour by about an hour and may increase the strength and pain of contractions, and that transfer to obstetric care is not advised for amniotomy alone. If there is no progress 2 hours later, delay is diagnosed and care moves to an obstetric unit. An oxytocin drip may then be discussed.

Oxytocin is given through a drip into a vein to make contractions stronger and more regular. The NHS says it can work quickly, so pain relief options are discussed first, and that you need electronic monitoring and regular vaginal examinations. NICE says an obstetrician should assess you in full first and that your choice to start, stop or restart it will be supported. NICE explains that, after the waters have broken, oxytocin will bring forward the time of birth but will not influence the mode of birth or newborn outcomes, and that it can cause hyperstimulation, which may raise the chance of temporary low oxygen to the baby; the dose is reduced or stopped if that happens. An epidural should be offered before it starts or if you ask for one later.

NICE says that if the cervix has opened by less than 2 cm after 4 hours of oxytocin, further obstetric review is needed to assess whether a caesarean is advisable.

The NHS says the pushing stage should last no longer than 3 hours with a first baby and no more than 2 hours after a previous baby. NICE sets out when to reassess: for a first labour without an epidural, after 1 hour of active pushing the team reviews progress, and if birth is not imminent after 2 hours a senior review decides on place and mode of birth; for later labours the checkpoints are 30 minutes and 1 hour. With an epidural, pushing may be delayed after full dilatation (up to 2 hours for first labours and 1 hour for later ones) before active pushing starts, and NICE says this can shorten the active stage.

If delay is confirmed, an obstetrician reviews you in person. Options can include oxytocin if contractions are weak, an episiotomy, an assisted birth with forceps or ventouse, or a caesarean, as Tommy's describes. Your team should explain why and ask for your consent.

The NHS says labour can be slower than expected when contractions are not frequent or strong enough, or when the baby is in an awkward position. An awkward position, such as a back-to-back baby, is one reason a team may look more closely at rotation and descent. Tommy's adds that you might need help if you have been labouring for a long time and are too tired, or if the baby's heart rate drops and a quicker birth is thought safer.

If you are at home and worried that labour is not progressing, or you are exhausted, in severe pain, or have any of the urgent features the NHS lists (waters breaking, bleeding, reduced movements), contact your midwife or maternity unit, using the number on your notes. If you feel your baby move less than usual at any point, do not wait. Dial 999 if you have heavy bleeding, collapse or severe pain. Arrangements for transfer between home, midwifery units and hospital vary by area and by UK nation.