Prolonged Latent Phase

If you have been contracting regularly for a period of 20 hours (14 hours if you’ve had a baby before) without a measurable change in your cervix, your midwife or doctor may make a diagnosis of “prolonged latent phase”. Under these difficult circumstances “patience” should be the guiding principle. Overly aggressive treatment (by rupturing the membranes and/or using Pitocin) may lead to an unnecessary c-section. Although the fatigue and frustration of prolonged latent phase is enough to convince some women that a c-section is in order, there is a tried and true alternative treatment that has “stood the test of time”……..(and don’t let this scare you)….that is, a big dose of morphine and a barbiturate-type sedative to produce a “therapeutic rest”. With Therapeutic Rest, a woman finds relieve from contractions and the body is allowed to rest…….many women wake up from this rest in much better labor, and some wake up to find that the labor has stopped….only to deliver another day. Since the drugs are given long before delivery, the effects on the baby are usually undetectable.

In some cases Prolonged Latent Phase may not actually be a component of the latent phase. It is quite possible that some or most of the women diagnosed in latent phase are actually in the preparatory phase. Many of the “failed” labors which result in cesarean section may be due to this misdiagnosis. It is acceptable practice to relieve the pain (often with an epidural) and attempt to induce labor. However, if the uterus and cervix have not been adequately prepared (by a woman’s own prostaglandin production) and an induction is begun, a doctor or midwife must have a high degree of patience to sit through what may be a very long labor. This is one difficult situation, for both the mother and the accoucheur, in which patience is a virtue……however, too often there are non-medical reasons which “force the hand” and trust in Mother Nature is thrown to the wind and trust is placed in the hands of mortals……this situation may lead to unnecessary c-secton.

What is the right thing to do? If you are a woman who feels she has been in labor for 20 hours with no progress, you may be quick to resort to delivery by any means. If you are a doctor or midwife with everything except time and patience on your hands, you may also be quick to make a decision to skip the labor and get to the delivery part. There are certainly no guarantees that at the end of a long labor a woman would not end up with a c-section anyway. But the overall risks should be significantly less than 50/50 that a c-section might be necessary. And, in 1999, vaginal birth is still the safest route into this world. But maternal exhaustion is a factor that must be addressed, and if for some reason, “Therapeutic Rest” is not an option, and the patience factor is in high supply, some medical intervention may be appropriate. The modern epidural, if managed properly, and a low-dose-Pitocin induction may be a good way to address all the factors. However, especially if it’s your first baby, the induction may take a while…..even as long as 24-hours. Put that on top of the 20 hours already invested.

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