What Happens If Labor Does Not Progress?

Words like "stalled," "prolonged," and "failure to progress" are often used as if they mean the same thing. Clinical guidelines draw clearer lines between them.

Key Takeaways

• The length of labor varies widely. Research used in current ACOG guidance found that active labor can progress more slowly than older labor curves suggested.
• Slow labor and labor arrest are different. ACOG defines arrest using specific criteria.
• Progress is judged on more than dilation alone. Guidance also refers to contractions, the baby's position and descent, and the condition of mother and baby.
• Upright positions and walking, fluids, continuous support, and water immersion have been studied as supportive measures. The evidence for each has limits.
• In a national study of United States birth centers, most transfers during labor happened for non-emergency reasons such as prolonged labor.

What Does It Mean When Labor Is Not Progressing?

In clinical terms, labor that is not progressing as expected is described as protracted or arrested. The American College of Obstetricians and Gynecologists (ACOG) defines labor protraction as progress that is slower than normal, and labor arrest as progress that has stopped despite attempts at augmentation.

Where you are in labor matters. ACOG describes the latent phase, sometimes called early labor, as a time of gradual and relatively slower cervical dilation, and considers active labor to begin at 6 centimeters. It notes that before then labor may take more than 6 hours to progress from 4 to 5 centimeters and more than 3 hours to progress from 5 to 6. WHO states that a dilation rate of 1 centimeter per hour is unrealistically fast for some women.

Slow, Stalled, Prolonged, or Arrested: What the Terms Mean

• Slow labor. Clinicians call this protracted labor. ACOG describes it as labor progress that is slower than normal.
• Prolonged labor. ACOG states that a prolonged latent phase may be defined as longer than 16 hours. It defines a prolonged second stage as more than 3 hours of pushing for someone who has not given birth before, or more than 2 hours for someone who has.
• Labor arrest. ACOG defines active phase arrest as no progression in cervical dilation in someone who is at least 6 centimeters dilated with ruptured membranes (waters broken), despite 4 hours of adequate uterine activity, or 6 hours of inadequate uterine activity with oxytocin augmentation.
• Stalled labor and failure to progress. These common terms do not appear in ACOG's 2024 labor guideline, which uses protraction and arrest instead.

How Midwives Assess Labor Progress

Clinical guidance describes labor progress using several findings together, not cervical dilation alone.

Cervical Change

During labor the cervix thins and opens, or dilates. WHO's definitions of the latent and active first stage of labor refer to both cervical effacement and dilation. In the pushing stage, ACOG's guidance on arrest refers to whether the baby is rotating and descending.

Contractions

Contractions are part of how labor arrest is defined. ACOG's definition of active phase arrest depends on whether uterine activity is adequate, and WHO's definition of the active first stage refers to regular painful uterine contractions.

Baby's Position

A baby who is head down but facing the mother's front instead of her back is in the occiput posterior position. ACOG lists this position among the risk factors for protracted or arrested labor, and supports frequent position changes in labor to promote optimal positioning of the baby.

Maternal and Fetal Well-Being

Guidance ties its advice to how the mother and baby are doing. ACOG describes waiting as reasonable in the latent phase as long as maternal and fetal status are reassuring, and WHO applies the same condition to its advice against using medical interventions to speed labor before 5 centimeters.

In low risk labors, the baby's heart rate can be checked at intervals, which is called intermittent auscultation. WHO recommends it for healthy pregnant women in labor, using a Doppler ultrasound device or a Pinard fetal stethoscope, and ACOG describes the use of a hand-held Doppler device for low risk women who want this type of monitoring.

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What May Help When Labor Is Moving Slowly?

ACOG lists several nonmedical supportive measures that have been suggested as ways to help labor progress, including continuous emotional support, hydration, water immersion, walking, and positioning. It also notes that these measures are difficult to study in a systematic way.

Changing Positions and Movement

A Cochrane review of 25 studies found that the first stage of labor was about 1 hour and 22 minutes shorter for women who were upright or walking than for those who were lying down, although the quality of the studies was variable. ACOG notes that a later review found no difference in the length of labor between positioning approaches. WHO recommends encouraging mobility and an upright position during labor for women at low risk.

Hydration and Food

ACOG notes that oral hydration can be encouraged in labor to meet hydration and caloric needs, and that women in spontaneously progressing labor may not require routine continuous IV fluids. WHO recommends oral fluid and food intake during labor for women at low risk.

Continuous Labor Support

A Cochrane review with data from 26 studies found that women who had continuous support during labor may be more likely to have a spontaneous vaginal birth and may have shorter labors. The evidence was graded low quality. WHO recommends a companion of choice for all women throughout labor and childbirth. A consensus statement from ACNM and two other midwifery organizations lists an unsupportive environment, including bright lights, lack of privacy, and lack of supportive companions, among the factors that disrupt normal physiologic childbirth. Read more about why continuous labor support matters and about adding doula support to your birth team.

Comfort and Pain-Relief Options

ACOG notes that water immersion during the first stage of labor has been found to lower pain scores without evidence of harm, and that massage and relaxation techniques may reduce pain. It also notes that none of the nonpharmacologic techniques have been found to adversely affect the progress of labor, although few have been studied extensively. Our guide to pain relief options at a birth center covers these in detail, and our water birth page explains laboring in water.

When Does Slow Labor Become a Concern?

Published guidance points to two things: whether labor meets the definition of arrest, and whether the condition of the mother and baby is reassuring. The points below are general clinical considerations drawn from that guidance and from birth center research. They are not any one center's transfer criteria.

• Active phase arrest, as ACOG defines it above
• In the pushing stage, a lack of rotation or descent of the baby despite adequate contractions, pushing efforts, and time, which ACOG describes as a sign of second stage arrest
• Non-reassuring fetal heart rate patterns, which were the most common reason for emergency transfer during labor in a national study of United States birth centers

ACOG also notes that protracted and arrested labor are associated with an increased risk of adverse outcomes, including cesarean delivery, postpartum hemorrhage, and admission of the newborn to intensive care.

What If Labor Still Does Not Progress?

ACOG states that labor management should address patient preferences and values through shared decision making. Options described in clinical guidance include:

• More time. ACOG notes that most people with a prolonged latent phase will ultimately enter active labor with expectant management, meaning waiting, and that cesarean delivery for a prolonged latent phase should be avoided when maternal and fetal status are reassuring.
• Physician care. The American Association of Birth Centers (AABC) notes that birth centers meeting its standards refer clients to physician care or transfer to a hospital if medical needs arise.
• Augmentation. ACOG's guideline covers amniotomy (artificial rupture of the membranes) and oxytocin as ways to augment labor. ACOG notes that oxytocin augmentation requires continuous electronic fetal monitoring.
• Medical pain relief. ACOG recommends that neuraxial anesthesia be offered for pain relief during any stage of labor, and WHO recommends epidural analgesia for healthy pregnant women who request pain relief during labor.
• Operative vaginal or cesarean birth. ACOG recommends cesarean delivery for active phase arrest, and suggests assessment for an operative vaginal delivery before cesarean for second stage arrest.

Questions you can ask your care team: How are my baby and I doing right now? What are the options, including waiting? What would make you recommend a change?

When Might a Hospital Transfer Be Recommended?

A transfer may be recommended when labor calls for care a birth center does not provide. New York State regulations for birth centers state that labor is not induced, stimulated, or augmented at the center with medications that act directly on the uterus, that general and regional anesthesia are not administered at the center, and that forceps and vacuum extraction are not permitted. The regulations also require birth centers to have written hospital transfer plans, including a list of situations that call for a transfer, developed with the receiving hospital.

The National Birth Center Study II followed 15,574 people who planned a birth center birth at the start of labor. Of these, 84 percent gave birth at the birth center and about 12 percent transferred to a hospital during labor. AABC notes that most of the transfers during labor happened for non-emergency reasons such as prolonged labor, that less than 1 percent of the study group transferred during labor for an emergency, and that 54 percent of those who transferred during labor went on to have a vaginal birth.

Our birth center is affiliated with a hospital, and our midwives attend births there, so families who move to the hospital keep a midwife they already know involved in their care. You can read more about how our midwives care for families in the hospital.

What This Can Look Like at a Birth Center

At Birthing Center NYC, labor care includes:

• Freedom to move, eat, drink, and choose comfortable positions
• Birthing stools and other tools for physiologic birth
• Birthing pools and private showers
• Waterproof fetal monitors, with monitoring done intermittently
• Continuous support through labor and birth
• A midwifery team with ready access to consultation with our medical doctors
• Clinical decisions made with you

Epidurals are not available at the birth center. If a client wants one during labor, the attending midwife arranges a transfer to a hospital. Our midwifery team supports birth at home, at the birth center, and in the hospital.

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Frequently Asked Questions

What does stalled labor mean?

"Stalled labor" is not a term used in ACOG's 2024 labor guideline. The guideline defines labor protraction, which is progress that is slower than normal, and labor arrest, which is progress that has stopped despite attempts at augmentation.

How long can labor take to progress?

There is no single timeline. WHO states that a standard duration of the latent first stage has not been established and can vary widely from one woman to another. It states that the active first stage, from 5 centimeters until full dilation, usually does not extend beyond 12 hours in first labors or 10 hours in subsequent labors. ACOG states that a prolonged latent phase may be defined as longer than 16 hours.

Can labor slow down and then start progressing again?

ACOG notes that most people with a prolonged latent phase will ultimately enter active labor with expectant management. WHO notes that labor may not naturally accelerate until a cervical dilation of 5 centimeters is reached.

Does slow labor always mean a hospital transfer?

WHO states that a slower than expected rate of dilation alone should not be an indication for obstetric intervention. In the National Birth Center Study II, 84 percent of people who began labor planning a birth center birth gave birth at the birth center.

Is slow labor dangerous for the baby?

ACOG notes that protracted and arrested labor are associated with an increased risk of adverse outcomes, including admission of the newborn to intensive care. WHO states that the 1 centimeter per hour dilation threshold is inaccurate for identifying women at risk of adverse birth outcomes.

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Talk With Our Midwifery Team

If the thought of a slow labor is on your mind, bring it to a prenatal visit. Your midwife can talk through how labor progress is assessed and how a change of plan would work for your pregnancy. If you are still exploring your options, you can schedule a consultation to talk it through.

Sources and References

• First and Second Stage Labor Management, Clinical Practice Guideline No. 8. American College of Obstetricians and Gynecologists.
• Approaches to Limit Intervention During Labor and Birth, Committee Opinion No. 766. American College of Obstetricians and Gynecologists.
• WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. World Health Organization.
• Continuous Support for Women During Childbirth. Cochrane.
• Maternal Positions and Mobility During First Stage Labour. Cochrane.
• Supporting Healthy and Normal Physiologic Childbirth: A Consensus Statement by ACNM, MANA, and NACPM. Journal of Perinatal Education.
• Outcomes of Care in Birth Centers: Demonstration of a Durable Model. Journal of Midwifery and Women's Health.
• National Birth Center Study II. American Association of Birth Centers.
• What Are the Stages of Labor? Eunice Kennedy Shriver National Institute of Child Health and Human Development.
• Delivery Presentations. MedlinePlus, National Library of Medicine.
• Section 754.3, Section 754.4, Section 795.3, and Section 795.4. New York Codes, Rules and Regulations, Title 10.

About the Author

Judy Ribner, DNP, CNM

Doctor of Nursing Practice and Certified Nurse-Midwife. Founder, Birthing Center NYC.

Judy Ribner is a Doctor of Nursing Practice and Certified Nurse-Midwife, and the founder of Birthing Center NYC in Brooklyn, New York. Her work centers on midwifery care, patient education, and helping families understand their birth options clearly enough to make decisions that fit their own pregnancy and health history.

This content is intended for educational purposes only and does not replace personalized medical advice from a qualified healthcare provider. Every pregnancy and health situation is unique, and individuals should discuss their care options with their healthcare provider.