Prolonged labor

　　The occurrence of prolonged labor is related to factors such as the mother's fear, excessive mental tension, uterine factors, abnormal fetal position, and endocrine disorders. The specific causes are described as follows.

　　1. If the mother has concerns, fear, and excessive mental tension about childbirth, she may mistake false labor for true labor, causing the cerebral cortex to become overfatigued and affecting normal uterine contractions. Abnormal uterine contraction strength is an important cause of prolonged labor.

　　2. Uterine factors: Twins, polyhydramnios, macrosomia, etc., can cause the uterine wall to stretch excessively, leading to the loss of normal uterine contraction strength; acute or chronic infection in the mother or uterus, poor development of uterine muscle, uterine malformation, and intramural fibroids. Elderly primiparas may have a rigid cervix that is not suitable for dilation.

　　3. Abnormal fetal position (such as transverse position), malpresentation, or pelvic tumors that block the passage can prevent the presenting part from compressing the lower segment of the uterus and the cervix effectively, thus not causing strong reflexive uterine contractions.

　　4. Endocrine disorders: Deficiency of estrogen or oxytocin and a decrease in acetylcholine during labor can all affect uterine contractions.

　　5. Drug effects: The use of a large amount of sedatives or excessive use of孕激素 during the maintenance of pregnancy can lead to uterine atony during labor.

　　6. Other: Overfatigue of the mother or overdistension of the bladder can affect uterine contractions.

　　Prolonged labor not only poses risks to the fetus but also to the mother. The risks to the mother are as follows.

　　1. Prolonged labor due to a long labor process can lead to poor rest for the mother, insufficient food intake, and the consumption of energy and strength, resulting in fatigue, weakness, intestinal distension, and difficulty urinating, which can affect uterine contractions. In severe cases, it can cause dehydration, acidosis, and hypokalemia.

　　2. Due to the prolonged second stage of labor, the bladder is compressed between the presenting part (especially the fetal head) and the pubic symphysis, which can lead to tissue ischemia, edema, necrosis, and the formation of vesicovaginal or urethrovaginal fistula. Premature rupture of membranes and multiple rectal or vaginal examinations increase the risk of infection. Postpartum uterine atony affects placental detachment, delivery, and the closure of blood sinusoids in the uterine wall, making postpartum hemorrhage more likely.

　　In the process of labor, any stage that is not smooth can lead to a long labor time and can be called dystocia. From the stage of labor pain to the full dilation of the cervix, if it is below twelve hours, it is considered normal. Many women are primiparas, and primiparas over twenty hours are considered dystocia. For women who have given birth before (multiparas), if they exceed fourteen hours, it is also considered dystocia; from the stage of full dilation of the cervix to the birth of the fetus, two hours within is normal delivery, and it is a normal situation. Over two hours is considered dystocia; from the time the baby is born to the delivery of the placenta, five to thirty minutes is normal, and over 30 minutes is considered dystocia.
　　1. Narrow pelvis outlet of the mother.
　　2. Abnormal fetal position or malpresentation: Due to the widespread use of prenatal B-ultrasound, most abnormal fetal positions (such as breech or transverse lie) can be detected; abnormal malpresentation (such as the fetus's posterior occiput in the posterior position) generally needs to be detected by internal examination during the labor process.
　　3. Fetal macrosomia: Fetal macrosomia is actually relative to pelvic inlet stenosis. Mothers with wider pelvises can deliver larger infants vaginally. In some special situations, fetal macrosomia is more likely to occur, such as mothers with diabetes or gestational diabetes, or those with a previous macrosomic baby.
　　In fact, even if the B-ultrasound estimate of fetal weight is accurate, it is difficult to predict shoulder dystocia caused by particularly thick shoulders of the fetus solely from the estimate of weight size, because the birth weight of such a fetus is not necessarily very heavy.
　　4. Fetal abnormality: If a fetus has congenital tumors such as spinal cord tumors, teratoma, fetal hydrocephalus, conjoined twins, etc., they can generally be diagnosed by B-ultrasound before birth.

　　Dystocia is harmful to both the mother and the fetus. The preventive methods start with eliminating the causes of the disease, including the following measures.

　　Firstly, it is necessary to make the primipara understand that pregnancy and childbirth are normal physiological processes, enhance her confidence in childbirth, eliminate unnecessary concerns and fear, and mobilize her subjective initiative. Pay attention to the diet, rest, and defecation of the pregnant woman, and avoid the excessive use of sedative drugs. For those with weak uterine contractions, close observation, careful analysis, and timely treatment are required. Early correction should be made for fetal malposition. It is not advisable to use too much gestagen during pregnancy preservation. Women with uterine diseases should be treated before pregnancy and then pregnant.

　　Dystocia is more common in primiparas, and the diagnosis of the disease is based on the weakness of uterine contractions and the weak uterine contraction during labor. The specific diagnosis is described as follows.

　　1. The occurrence of dystocia is more common in primiparas, and factors such as mental tension, twins, polyhydramnios, and abnormal fetal position are involved.

　　2. The uterine contractions during labor are weak, short, and long in intervals, and even irregular. At the peak of uterine contractions, the anteroposterior diameter of the uterus increases slightly, and the finger feels soft when pressing the uterine wall. The mother feels that the pain of uterine contractions is relatively mild.

　　3. The uterine contractions are not very strong, but the contractions in the lower segment of the uterus can be stronger than those at the fundus. The uterus is not fully relaxed during the intermission, leading to unclear fetal heart and position checks, or the mother feeling pain and restlessness.

　　Dystocia mothers should choose foods with high nutritional value and calorie content, and eat semi-liquid soft foods with a high water content before labor. The specific dietary precautions are described as follows.

　　1. First of all, the food should have high nutritional value and high calories. There are many such foods, common ones include: eggs, milk, lean meat, fish and shrimp, and soy products, etc.

　　2. During labor, a lot of water is consumed, so the mother-to-be should eat semi-liquid soft foods with a high water content before labor, such as noodles and rice porridge.

　　3. To meet the mother-to-be's need for calories, eating some chocolate (not too much) before labor is very beneficial. Chocolate is rich in fat and sugar and has a high calorific value, which is especially suitable for those who cannot eat food during labor.

　　4. After the mother-to-be enters the labor stage, it is advisable to take the method of promoting the opening of orifices and facilitating labor in diet regulation, which has a positive effect on promoting labor, shortening the labor process, and reducing labor pain. It is especially important for primiparas, those with larger fetal bodies, or those with sticky birth canals. Foods in this category include: Malva verticillata leaves, amaranth, Portulaca oleracea, cow's milk, honey, lotus root, and rabbit brain, etc.

　　5. The folk custom is to let the mother-to-be eat sugar (or brown sugar) and lie on eggs, or eat a bowl of braised noodle with egg or egg custard before labor. These are all suitable foods before labor. However, eating too many eggs will increase the burden on the gastrointestinal tract and can cause symptoms such as stopping eating, indigestion, bloating, and vomiting, and even more serious consequences. Therefore, 1 to 2 eggs per meal are enough for the mother-to-be.

　　During the process of labor, any stage that is not smooth can lead to a prolonged labor time and can be called dystocia. Dystocia is often caused by disharmony of Qi and blood, cold stagnation of Qi, or the fatigue and weakness of the mother. Dystocia mothers can choose cesarean section to deliver the fetus.