The rationale for a transfer due to labour dystocia is because abnormally prolonged labours are associated with things like fetal hypoxia (impaired oxygenation), shoulder dystocias, and postpartum hemorrhage in addition to other minor things like maternal exhaustion. So things many midwives would rather not encounter at home........ Then ofcourse if your waters are broken, there's the increased risks of infection etc etc......
One of the main problems with managing prolonged labours is the subjective nature in it's definition as mentioned by Jenni. More often then not most "labour dystocia's" are diagnosed before actual active labour even begins. According to medical guidelines, a woman is not in labour until she is 3-4cm with a first baby and is having regular contractions that are dilating the cervix or she is 4-5cm with a subsequent baby and is having regular contractions that are dilating the cervix. Unfortunately, there are many times that women teeter on the cusp of is she in active labour? or is it prodromal that may just fade away if given time to progress naturally? and in our society medical professionals and the women themselves often push for it to be "real" labour even when it isn't and then when they remain 3cm for hours and hours and the contractions start to fade away they intervene and augment when the woman could have just carried on at home, had a nice long bath, slept some (gravol can be wonderful for this) and then go into "real" labour hours or days or even weeks later when her body is actually ready. So essentially, one of the best things one can do in ensuring that labour progresses normally is ensuring one is in actual active labour before even assessing it's progress! And that's why many women feel strongly about delaying contacting their midwives until labour has been well established.
Then once you're assessed to be "in labour" labour progress is assessed by Friedman's curve which states that in a normal progressing labour a woman will dilate atleast 0.5cm every hour for a first baby and atleast 1cm every hour for subsequent babies. It has become standard practice for care providers to assess the cervix every four hours to ensure that the woman remains on that curve. Not ideal but that's what they do. Most good midwives however will incorporate other components of progress like changes in fetal position, station, cervical effacement, etc into account. If a woman hasn't progressed in dilation in 4 hours but during that time the baby has turned from posterior to anterior and has moved down from -1 station to 0 that progress should and must be taken into account. The big picture needs to be looked at and while some midwives are excellent in doing this unfortunately some will not and will act prematurely in suggesting transfer to hospital.
Then there's the pushing stage. There's alot of debate as to what is "normal" when it comes to second stage lengths and there really isn't much consistency within the medical guidelines of different obstetrical establishments but for the most part 3 hours is thought to be the maximum limit of time for pushing a first baby out and 2 hours is thought to be the maximum amount of time for pushing a subsequent baby out. But again it's definitly not a black and white thing. There's alot of grey inbetween and the big picture has to be looked at. If a woman's pushes are fairly ineffective for the first 2 hours but in the last hour she gains some oomph and gets into it and really brings baby down and that baby appears to be coping just fine then pushing for another hour or so without intervening can be a completely appropriate action iykwim.
Then there's the additional consideration of a latency period between becoming fully dilated and needing to push. Some women feel an urge to push right away after they become fully dilated and sometimes even slightly before while others get a "rest and be thankful" phase where the contractions space out abit become a little less intense but the urge to push is just not there yet. Some practitioners are simply not comfortable with this phase while other guidelines (eg the SOGC) strongly suggest that it is completely acceptable for women without epidurals having their first babies to wait up to 2 hours after full dilation for that urge to push to occur and that women having subsequent babies can wait an extra one hour before being put on that second stage progress clock. By allowing this latent stage, the incidences of using oxytocin for augmentation, fetal heart rate abnormalities as well as the need for forceps or vaccuum deliveries are reduced. So that is definitly a consideration when it comes to assessing progress during the second stage. And if your midwife isn't taking this latent stage into account it may be of benefit for you to if it does occur.
Then distance to hospital plays a role. If you're 5 minutes from the hospital then most midwives are likely to be give you more time when it comes to progressing whereas if you are 45 minutes away from hospital (for example me) the midwives will have a stronger urge to transfer sooner then later.
And ultimately it's your body and your baby and your birth. You're the ultimate decision maker and you can refuse transport into hospital if you don't feel that it's an appropriate action given the situation. If things slow down, it doesn't at all mean things will stay slowed and there are lots and lots of things one can do to get labour progressing again and any good midwife will implement a myriad of different techniques to speed things up in the face of labour dystocia to avoid transport in. There's position changes, walking, getting in and out of water, nipple stimulation, etc etc etc (Penny Simkin's labour progress handbook is a lovely book btw). Then there's more invasive things like IV hydration if your becoming dehydrated or amniotomy that can be done at home to facilitate progress. Overall, if baby is otherwise well and you feel like you can continue on then it's completely appropriate for you to implement such strategies before you head out the door. And do keep in mind ALL of the indications of fetal progress and keep an eye on the BIG PICTURE when determining if there really is an issue.
Best of luck to ya!
In all likelihood you'll just fly through your labour and progress won't be an issue at all!
That is the greatest description ever.
