Prolonged Labor and Cerebral Palsy
This article has been fact checked by a Board Certified Pediatrician. Sources of information for the article are listed at the bottom.
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Cerebral palsy is a neurological condition that usually occurs during fetal development, during childbirth, or shortly after a baby is born. The condition largely affects movement and muscle tone, but can include far-reaching complications, like vision or speech difficulties, that range from mild to severe depending on the individual.
Cerebral palsy is damage to the part of the brain that controls muscles and motor skills. There are many different things that can cause this brain damage, including oxygen deprivation or maternal infections. There are also risk factors and an important one is prolonged labor. When a woman has prolonged labor her baby is at a greater risk of experiencing damage that causes cerebral palsy.
What is Prolonged Labor?
Prolonged labor is also referred to as “failure to progress.” It refers to labor that goes on for about 18 to 24 hours after regular contractions begin. For twins, a labor that goes on for 16 hours is considered prolonged. Mothers having their first baby are expected to be in labor for a longer period of time, so prolonged labor may not be declared until 22 to 24 hours, whereas for second or third-time mothers labor may be considered prolonged after 16 to 18 hours.
What Causes Prolonged Labor?
There are many potential causes for experiencing prolonged labor. A baby that is very large may cause labor to take longer because it cannot move through the birth canal. A breech position—with the baby’s feet or bottom positioned to emerge first—may also cause prolonged labor. Other possible causes are an abnormally small pelvis or birth canal in the mother, weak uterine contractions, a slow-effacing cervix, or even severe anxiety or stress in the mother.
Treating Prolonged Labor
If labor is taking an unusually long time, a woman’s doctor or nurses will monitor her carefully for the timing of contractions and their strength. They will also monitor the fetal heart rate and the mother’s vital signs. If the prolonged labor continues, contractions seem too weak, or the health of the mother or baby is at risk, there are steps that can be taken to speed delivery.
If the baby is already in the birth canal, but delivery is still taking a long time, a doctor may use instruments like forceps or a vacuum extractor to help pull the baby out. If the baby has not progressed that far, the mother may need to take a medication, called Pitocin, to speed up and strengthen contractions. This can help delivery progress better, but if it does not help enough or if the risks to the health of the mother or baby are deemed significant, the doctor may perform a Cesarean section.
Prolonged Labor Puts Women and Babies at Risk
A study that looked at over 120,000 women found that prolonged labor during the second stage—after the cervix has dilated to ten centimeters—posed serious risks for the mother and her baby. The mothers experiencing prolonged labor were more likely to have postpartum hemorrhaging, obstetric trauma, infections, or a combination of health problems.
Babies born after a prolonged second stage of labor were found to be at a greater risk for a combination of health issues, for being admitted to the neonatal intensive care unit, and for having a low score on the 5-minute Apgar test.
The Apgar test is evaluated at one minute and five minutes after birth to determine how well the baby is faring. It looks at things like heart rate, muscle tone, reflexes, breathing, and skin color. Low scores are associated with difficulty breathing, a low or absent heart rate, low muscle tone, low or no reflexes, and blue skin color. A low score has also been associated with later diagnoses of cerebral palsy.
How Prolonged Labor Can Lead to Cerebral Palsy
Results from studies are clear: prolonged labor puts children at risk for developing cerebral palsy. Exactly why this is true is not completely understood or may not be known in every case, but there are several likely possibilities. If labor is prolonged, but the baby is already in the birth canal, the doctor may use instruments to pull the baby out. The use of forceps or a vacuum extractor can cause damage to a baby’s skull, literally by crushing it with too much force. This can easily lead to the brain damage that causes cerebral palsy.
The most common cause of the brain damage that leads to cerebral palsy is oxygen deprivation to the fetus or newborn, also known as birth asphyxia. The longer the baby is deprived of oxygen, the more severe the damage may be. Things that can cause birth asphyxia are also associated with prolonged labor: hemorrhaging, a large baby that gets stuck on the mother’s pelvis, complications with the umbilical cord, shock in the mother, tearing of the placenta from the uterus, and an abnormal presentation of the baby as it emerges from the uterus and birth canal.
Prolonged labor is a problem that many women face when giving birth. It can cause a number of problems, but with the right care from doctors and nurses, there do not have to be any lasting complications. Unfortunately for some children, this difficult labor will result in complications that cause brain damage, and ultimately cerebral palsy.
Early diagnosis and treatment for prolonged labor is crucial for the best outcomes. Many cases of cerebral palsy could have been avoided with better medical care. If you had prolonged labor and your child was diagnosed with cerebral palsy, you may be able to file a lawsuit to prove that your medical care was inadequate and seek the justice and compensation your child needs to live with this condition.