This is defined as a failure of the cervix to dilate beyond a certain point, as a failure of the presenting part to descend, or as a failure of the woman to give birth after being in labor for a specified number of hours. Its only cause should be cephalo-pelvic disproportion (where the baby’s head is too large for your pelvis) but is more commonly due to tension, of which you may not consciously be aware, preventing you from dilating.
This is unlikely to happen at home, where women are more likely to be allowed to labor for as long as necessary without arbitrary time limits set upon the length of their labor. The only situation where home is not likely to be less inhibiting than hospital is where you have someone present who is clearly anxious or disapproving. If your labor is very slow or stops for this reason (and many women who have their babies at home report this phenomenon in the presence of visitors), you must ask them to leave. Clearly this can be difficult, but it is more important that your labor progresses satisfactorily than that other peoples feelings are protected, even if that person is your midwife or your partner. In fact a skilled and sensitive midwife should be able to see when this is happening and facilitate a change.
If it is the midwife who is causing the problem through her attitude, then you must ask for a change, or at least ask her to stay in another room until called. You have the right to ask for any midwife to be changed if you are not getting on well. This applies in advance, so that if, during your antenatal care, you encounter a midwife that you feel certain you would not want in labor, write to the local midwifery supervisor and request that this particular midwife is not sent to you when you are in labor. You do not have to give a reason, but it will help the supervisor to improve the service if you tell her of anything that this midwife has done or said to you that you feel is unprofessional. Sometimes it will be what she does not say or do, she may just be very unenthusiastic and it is as well to protect yourself from such negativity beforehand. The option of changing the midwife may not be open to women living in very isolated areas or where units are short-staffed, but it is none the less worth expressing your feelings. If you are having good contractions and feel relaxed, and yet labor is not progressing, there may be some disproportion, although it is unlikely if it is not your first baby. If the baby is not distressed, try squatting. If there is true failure to progress and the baby is in distress, you will need to be delivered in hospital, perhaps with forceps, ventouse or by Caesarean. However it is quite possible for labor that is allowed to take its own course to last over 40 hours (not all of this will be very painful) and, although this is exhausting, you may prefer it to a hospital delivery. In this situation you need lots of encouragement, good food and as much rest as you can get. Sometimes contractions cease so that you can get some sleep and then begin again later.
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