Two different things called stalling

"Labour has stalled" is used for two situations that have almost nothing in common. One is normal and expected. The other has a clinical definition and a pathway attached to it. Working out which one you are in is the first step.

Before established labour: stopping and starting is normal

NICE writes the unpredictability into its definition. The latent first stage is "a period of time, not necessarily continuous, when there are contractions and there is some cervical change".

Tommy's describes the experience: "This latent stage is not always a smooth process. You may feel as though the contractions are getting more regular, only for them to slow down or stop for a while." Elsewhere: "You may get lots of regular contractions and then they may slow down or stop."

Nothing has gone wrong when this happens, and it is not something to fix. Tommy's frames the purpose: "The latent stage is usually the longest part of labour, but this is for good reason. Your womb muscles need this time to build towards the first stage of labour."

The practical response is the same as for the rest of the latent phase. The NHS: eat and drink, sleep if it is night, stay upright and gently active if it is day, and use a bath, breathing or massage for the pain. NICE advises that "breathing exercises, having a shower or bath, and massage may reduce pain during the latent first stage of labour".

The HSE's advice on timing is useful here too: start timing "when they get stronger or closer together", and time three in a row rather than every single one. Timing every contraction through a stop-start latent phase is a good way to exhaust yourself for no information.

What is worth doing is telling your midwife. NICE instructs staff to "recognise that a woman may experience painful contractions without cervical change and offer her individualised support and analgesia if needed". A long, stop-start latent phase is exhausting, and support and pain relief are things you are entitled to ask for rather than endure without.

Once labour is established: what delay actually means

Established labour, by NICE's definition, is regular contractions with progressive cervical dilatation from 4 cm. From that point there is a measurable definition of delay.

NICE recommendation 1.8.42 says that when delay is suspected, all aspects of progress should be assessed, including:

Cervical dilatation of less than 2 cm in 4 hours for first labours.
Cervical dilatation of less than 2 cm in 4 hours, or a slowing in the progress of labour, for second or subsequent labours.
Descent and rotation of the baby's head.
Changes in the strength, duration and frequency of contractions.

Note that dilatation is only one of four things being weighed. Progress is not just centimetres.

What happens next, step by step

NICE sets out a sequence, and knowing it in advance makes it far less alarming when it starts.

Support first. "Offer the woman support, hydration, and appropriate and effective pain relief." And separately: "Offer all women with delay in the established first stage of labour support and effective pain relief."
A conversation. "If delay in the established first stage of labour is suspected, discuss the findings and the options available with the woman, and support her decision."
A repeat examination two hours later. "Advise all women with suspected delay in the established first stage of labour to have a vaginal examination 2 hours later, and diagnose delay if progress is less than 1 cm."
Amniotomy considered. If delay is diagnosed, NICE says to "consider amniotomy for all women with intact membranes, after explanation of the procedure and advice that it will shorten labour by about an hour and may increase the strength and pain of contractions".
Another examination two hours after that. "If there is no progress 2 hours after the amniotomy, diagnose delay and transfer the woman to obstetric-led care."
Obstetric review. "For all women with confirmed delay in the established first stage of labour, an obstetrician should offer a full assessment", including abdominal palpation, vaginal examination and consideration of oxytocin.

If oxytocin is used, NICE requires that you are told it "will increase the frequency and strength of contractions and that its use will mean that her contractions and her baby's heartbeat will be monitored continuously". Continuous monitoring is part of the package, not a separate decision.

Delay in the second stage

The reassessment points are built into the expected durations. For a first baby without an epidural, birth is expected within 3 hours of the start of active pushing, with a reassessment after 1 hour and a senior review if birth is not imminent after 2 hours. For a second or later baby, the equivalents are 2 hours, 30 minutes and 1 hour.

At each reassessment NICE looks for "signs of progress (in terms of rotation or descent of the presenting part)". If there are, you are encouraged to keep pushing. If not, delay is diagnosed and escalated.

NICE also says that if there is delay in the second stage, or "if the woman is excessively distressed", staff should "provide support and sensitive encouragement and ask her if she needs analgesia or anaesthesia".

What you get to decide

More than people assume. NICE requires that findings and options are discussed with you and that your decision is supported. Vaginal examinations are offered, not imposed: you can "decline the examination before it starts, or ask to stop at any stage during the examination".

Amniotomy and oxytocin are both preceded by an explanation and a discussion. And NICE puts a brake on unnecessary intervention: "Do not offer or advise clinical intervention if labour is progressing with no complications or concerns and the woman or pregnant person and baby are well", and "do not routinely perform amniotomy if labour is progressing".

Useful questions: how much have I changed since the last examination, what are you seeing besides dilatation, what happens if we wait another two hours, and what would change your mind.

When a stall is not just a stall

The NHS lists the reasons labour can be slower than expected: contractions not coming often enough, contractions not strong enough, or the baby being in an awkward position. Those are managed as above.

What changes the urgency is anything else happening at the same time — bleeding, a change in the baby's heart rate, a temperature, or your feeling that something is wrong. NICE notes that other risk factors alongside delay "may increase the urgency of the transfer".

When to call someone

Your midwife or maternity unit if contractions have slowed at home and you are unsure what to do. NICE expects telephone triage and a plan of care, including who to contact next and when.
Urgently if your waters break, you have bleeding, your baby is moving less than usual, you are under 37 weeks, a contraction lasts longer than 2 minutes, or you have 6 or more contractions every 10 minutes (NHS).
Your midwife, in the room, if you are exhausted or in pain that is not being managed. Support and effective pain relief are named parts of the guideline.
Your local emergency number if you feel a strong urge to push and think the baby is coming.

The short version

Contractions that stop and start before established labour are normal and written into NICE's own definition. After 4 cm, delay means less than 2 cm of change in 4 hours, and it triggers support and pain relief first, a repeat examination two hours later, then amniotomy, then obstetric review. At every step the findings are meant to be discussed with you.

When Labour Stalls