Attorneys for Prolonged and Difficult Labor Complications in New Jersey
Otherwise healthy pregnancies ending in long, difficult labor are what medical professionals call labor dystocia. Stalled labor, otherwise known as prolonged labor, could be due to a slow-dilating cervix or the baby’s inability to move down the birth canal, while another reason may be the baby’s size. After a child’s head is delivered, the shoulders should follow. If the shoulders are too wide or become stuck, the baby may not deliver naturally, increasing the chance for injury, a specific type of complication known as shoulder dystocia. These are just a few examples of what may cause labor to go on for too long and become extremely stressful for the woman delivering, as well as her soon-to-be newborn. Obviously, most childbirths place a relative amount of strain on the mother, but prolonging this process past a certain point and failing to respond to severe difficulty is far different, opening the door for complications, possible medical malpractice, and liability. Labor dystocia can be dangerous to the health and life of both mother and baby, so medical practitioners must know how to expertly mediate the line between assisting labor and performing a cesarean section, which has its own dangers and drawbacks.
The Stages of Labor
The American College of Obstetricians and Gynecologists (ACOG), as well as other obstetrical organizations, recommend lowering cesarean section birth rates. As such, birth assistants and professionals must know how to safely facilitate natural labor without rushing to surgical delivery. Expanding the definition of labor dystocia is one way to improve c-section rates. To clarify, labor is divided into two stages determined by cervical dilation. First stage is the labor, meaning contractions that open or dilate the cervix, measured in centimeters. The first stage applies to a range between 4 and 6 centimeters, while the second or active stage of labor is measured from 4 to 6 centimeters until birth, when the baby is ultimately pushed out of, or removed from, the canal. The cervix is where the baby exits the womb, so it must be open enough to allow the fetus to travel through.
What Causes Failure to Progress in Labor?
Labor may be stalled or obstructed due to the cervix’s extremely slow dilation, known as cervical dystocia. Other causes of labor that goes on for too long include the fetus moving too slowly down the birth canal, or shoulder entrapment after the head has been delivered. The ACOG considers abnormal labor from weak contractions, position or size of the child, or disproportion between fetal size and mother’s pelvis to qualify as labor dystocia.
What is Considered Prolonged Labor?
Dr. Emanuel Friedman’s 1955 published study measured the average time spent in labor to produce one centimeter of cervical dilation. Known as Friedman’s curve, doctors use this measurement to determine when labor stops progressing. Friedman measured normal labor from the onset, abnormal labor being those that progressed too slowly or stopped. For first-time mothers, 20 hours’ total labor time was deemed normal and 14 hours was deemed appropriate for experienced mothers. Abnormal labor or dystocia was considered reaching only 1 centimeter after 2 hours of labor for a first-time mother and 1.2 to 1.5 centimeters for mothers with previous pregnancies. In second stage active labor, dystocia is considered after 1 hour of pushing and the fetus has not descended the birth canal or 2 hours for women with previous pregnancies, adding an additional hour if pain relief medication is used.
Nevertheless, the ACOG and other leaders in the medical community have come to recognize that Friedman’s definitions of normal and abnormal do not fit a modern interpretation. In essence, redefining the threshold for prolonged versus typical labor duration must account for the current situation, in which technology and improved knowledge have expanded providers’ abilities to monitor the fetus and assist the mother in labor. Since Friedman’s determination of dystocia, new standard practices, such as induction and use of Pitocin, local anesthetics, and fetal heart rate monitoring, improve vaginal birth success.
Today, slower rates of progression during labor are considered more acceptable. Now, 6 hours in the first stage to increase dilation by a single centimeter and 3 hours in the second stage to move the baby are admissible. More recent studies confirm that average labor for vaginal birth is longer than the parameters set by Friedman. Studies show women take longer to dilate fully to 10 centimeters and longer to push the baby down the canal.
Redefining Labor Progression to Avoid Unnecessary Cesarean Deliveries
To avoid the risks associated with failure to progress, doctors traditionally rush to cesarean section. However, c-sections and related errors also have the potential to cause maternal bleeding, bladder injury, blood clots, and injury to other organs. Moreover, cesarean births increase the likelihood of placenta problems like placental abruption in future births. Thus, preventing cesarean delivery is a crucial step in improving care for expectant mothers and newborns, and protecting their future health. To that end, redefining normal labor may help doctors to choose correctly among labor dystocia treatment solutions. Losing outdated ideas about how long is too long, is where the improvement begins.
Guidance indicates that physicians should not rush to cesarean or other interventions to extract a baby in a labor that is progressing, though slowly. In fact, recent studies suggest that measuring cervical dilation progress in graphs, rather than time, is advisable. This method helps medical professionals to track labor progress not in hours, but in visual displays. In that way, physicians can take a more detailed look at labor progress, rather than simply defaulting to time limitations. In addition, physicians should start counting time from the start of the membranes rupturing, as opposed to beginning their timeframe with the start of contractions.
How do Doctors Manage Prolonged Labor?
As for interventions, recent reports and practices recommend changing the mother’s position or compelling her to walk during labor to aid with progression. Other suggestions include using various pain relievers and timing them along the labor path, as well as spacing out maternal labor progress checks and fetal monitoring to avoid the rush to c-section. Alternative options when labor is stalled include medication and instruments, like forceps and vacuum extractors. Moreover, women with labor support often do not need as much pain medication and may have a better childbirth experience overall. Finally, the timing of induced labor through oxytocin, as well as various methods to help a mother deliver vaginally, help to prevent surgery. To prompt labor to move along, doctors traditionally use low doses of oxytocin in long intervals. However, higher doses of oxytocin hastens labor, rather than low doses over a longer time. Now, high doses of oxytocin, along with breaking membranes, can be used to speed up delivery safely.
In addition, avoiding premature induction before 41 weeks and confining the use of epidurals to cases in which the mother can continue without excessive pain, may assist with reducing the time spent in labor prior to delivery. If the baby is facing the wrong direction or otherwise in a position that obstructs vaginal birth without injury, properly educated and trained physicians may be able to employ maneuvers that reposition the fetus while still in the womb. Overall, physicians should be up to date on the latest studies, technology, and practices to accomplish the dual goals of skillfully managing labor dystocia and preventing complications or unnecessary cesarean births.
Complications from Labor that Goes on for Too Long
Notably, there are cases wherein an immediate or emergency c-section is absolutely necessary to protect the health and well-being of both parties involved. When labor stops progressing, both the mother and infant run the risk of infection. Likewise, the fetus risks fetal distress and brain damage from reduced oxygen, and the laboring mother may hemorrhage, rupture her uterus, or injure her pelvic floor and vagina. Knowing when to order and perform a cesarean or initiate another treatment mechanism is critical during the birthing process. In actuality, allowing a labor to go on for too long without progression may cause severe complications and birth injuries. It may also amount to medical malpractice.
Injured during Prolonged Labor in NJ?
If you or your baby experienced complications due to mismanaged prolonged and difficult labor, contact us at 973-435-4551 to speak with a lawyer at Fronzuto Law Group regarding your case free of charge. Understanding your options and having the birth of your child thoroughly reviewed by a New Jersey labor and delivery malpractice attorney is a necessity when you are facing the uphill battle of medical bills and other loss incurred as a result of negligently handled prolonged birth. We encourage you to get answers to your unique questions by connecting with our group of seasoned attorneys today.
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