Common Causes of Stalled Labor and What You Can Do

Pregnant people go through predictable stages of labor. But each childbirth experience is unique and goes at its own pace. When a pregnant person is in active labor and the process slows down or stops, it is called "stalled labor." If this happens, you'll likely be wondering, "Why did my contractions stop?" Possible reasons include exhaustion, lying in bed, weak contractions, contractions without dilation, or the baby not descending, despite contractions still occurring.

A stalled labor can feel distressing and discouraging, but it's often short-lived. The good news is that stalled labor doesn't usually pose any danger and can often be resolved. Here's everything you need to know about stalled labor, from what the term means to things you can do to help the labor process get going again.

What Is Stalled Labor?

Stalled labor, sometimes referred to as prolonged labor or abnormal labor, occurs when labor ceases, pauses, progresses too slowly, or fails to progress. "Prolonged labor" refers more to a set period of slow-moving labor, while "stalled labor" can mean labor that stops for various amounts of time.

According to the American College of Obstetricians and Gynecologists, labor is considered prolonged when it exceeds a certain length of time, commonly defined as when a pregnant person has been in active labor for 20 hours or more. Periods of stalled labor can last for an hour to a few hours or more. This is also referred to as "prolonged second stage."

Everyone's labor goes on its own timetable but stalling for over 2 hours (or 3 hours with an epidural) is considered abnormal. If you've given birth before, you're allotted 1 hour (or 2 hours with an epidural), before your labor is considered stalled.

What Causes Stalled Labor?

Many things can cause labor to stall, including:

• Your baby's position: How your baby is positioned can affect the length of your labor. A baby is considered "malpositioned" for birth when they are not head down facing your back or left side. Correcting the baby's position could mean an easier, quicker labor. If you or your care providers suspect that your baby's position is causing issues with your labor, walking and changing positions can help correct this.
• Emotional stress: Underlying emotional or psychological stress can cause labor to stall or slow down. Known as "emotional dystocia," this can be anything from an extreme fear of pain to trauma, unease, or not feeling safe.
• Exhaustion: While sleeping doesn't cause labor to stall, sleep deprivation, fatigue, and staying in a reclined position have been shown to slow and lengthen labor.
• The size of the baby or your pelvis: If your baby is large or your birth canal is small, labor may stall out because your baby has nowhere to go. In these cases, a cesarean section will likely be suggested.
• Using an epidural: Some studies have shown that epidural use can slow down the pushing phase of labor, and while data is inconclusive of its effect on active labor and transition, many report that their contractions weaken and space out after receiving an epidural, often leading to the use of Pitocin (synthetic oxytocin) to get contractions going again.

If you have any underlying issues that you think could impact your labor, notify your birth team (partner, doula, doctor, midwife, nurse). They will help you deal with the emotions and concerns coming up during your labor, reassure you of your safety, and support you during the process.

What Can You Do If Labor Stalls?

If labor stalls, take heart in knowing that the pause is most likely temporary. In many cases, labor resumes on its own. There are, however, things that you can do to encourage labor to progress.

Rest

If you can manage to rest—and if you are not being encouraged to get labor going again—take advantage of the time. Labor is hard work, and any opportunity you can take to rest will help your body recharge. Being overly tired is associated with a longer labor—and preterm labor. However, if you are actually in labor, your contractions won't slow down or stop simply because you fall asleep. So aim to relax and rest as much as you can between contractions.

Walk or change position

Walking or changing your position while in labor can work wonders for progression. Gravity and bodily movements can help the baby descend and get into a more optimal position. Sometimes, a few good squats are all it takes to cross the threshold of a stalled labor. If you're lying down, get upright. If you're sitting on a birth ball, try standing, squatting, or walking around.

If you're experiencing back labor, try stair walking or side lunges. If you are laboring with an epidural, you can still use movement and position changes to help your labor progress. Rolling over, for example, can be helpful. Ask your support people to help, if needed.

Consider nipple stimulation

Nipple stimulation (by way of rolling your nipples between your thumb and pointer finger or rubbing your nipples with your palm) is a very effective tool for bringing on longer and stronger contractions. Ask your doula or nurse to provide you with more information on this practice. They might want to accompany nipple stimulation with fetal monitoring.

Change your environment

Sometimes, your environment (especially in the hospital) can cause a mental or emotional block that stalls labor. Are the lights too harsh? Is the presence of your mother-in-law disturbing you? Are there too many nurses coming in and out? Environmental stimulus can impact the progress of labor. Dimming the lights, asking for some privacy, turning on music, and spraying lavender oil are just some of the ways you can change your environment and enter a more relaxed state.

Shower

It may take some convincing, but getting into a shower during labor can help you relax and may help intensify contractions. The water and heat release feel-good endorphins, and when you face the water, the stimulation on your nipples releases oxytocin, the hormone responsible for contractions.

How Is Stalled Labor Treated?

If rest and the aforementioned suggestions do not work, your doctor or midwife may suggest some form of medical intervention. Pitocin may be administered, for example, or your "water" may be broken. These steps often jumpstart labor. A cesarean section may also be recommended if the stall continues and you or your baby are in distress.

That said, it's important to note that unless you or your baby are at risk, you have a say in the matter. If your health care provider recommends Pitocin, find out if it's medically necessary. You can ask: Is my baby healthy? Am I healthy? What are the risks of continuing to labor without Pitocin? If your care provider recommends a cesarean, repeat the same questioning. And, when in doubt, ask for more time. If your baby is not in distress, and you are comfortable, most health care providers will honor this request. However, if you or your babyare not doing well, medical interventions can be life-saving.