Failure To Progress: What Is It, Anyways?

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For a long time, “failure to progress” was determined based on “Friedman’s Curve,” a graph which outlined the “appropriate” length and pace of labor for both first-time and second-time (or more) birthing women. According to Friedman’s curve, during a first-time labor the cervix should take no more than 14 hours to dilate from zero to ten centimeters, and an experienced mom’s cervix should take no more than 8 hours to make the same progress.


While this standard of labor management has been around since the 1950s, in 2014 The American College of Obstetricians and Gynecologists(ACOG) updated the recommendations to reflect results from a 2010 study which indicated that “Friedman’s Curve” is simply not the curve most modern births follow.

SO WHAT ARE THE NEW GUIDELINES?


There are many, but here are the highlights!


-Early labor (also referred to as the “latent phase”) which lasts longer than 20 hours for first-time birthers and 8 hours for experienced birthers shouldn’t be an indication for a cesarean.

-A slow first stage of labor (everything prior to pushing) shouldn’t be an indication for a cesarean, either, as long as progress is being made.

-A birthing woman isn’t in active labor until the cervix has dilated to at least 6cm.

-Cervical progress prior to this threshold (6cm) shouldn’t be held to the standards of active-stage progress.

-Cesarean delivery isn’t indicated for active-phase arrest in the first stage of labor unless a) the birthing woman has reached the 6cm threshold and their water has broken and progress has not been made with 4 hours of adequate contractions, or b) the birthing woman has reached the 6cm threshold and their water has broken but they are experiencing inadequate contractions and no cervical progress after at least 6 hours of pitocin administration.

-Before an arrest of labor (or “failure to progress”) in the second stage (i.e. during pushing) is determined, a woman birthing for the first time should be allowed at least 3 hours of pushing, and an experienced birthing woman should be allowed at least 2, and longer pushing phases may be allowed on a case-by-case basis as long as progress is being made.


(You can find the rest if the updated guidelines here. Enjoy!)


Now that we know how true labor arrest/failure to progress is defined and when it may be diagnosed, you may be wondering…


WHAT CAUSES LABOR TO ARREST?


In short? So. Many. Things.


According to The American Pregnancy Association, “…if the baby is too large, the birthing canal is too small, or the woman’s pelvis is too small, delivery can take longer or fail to progress.” Carrying multiples, weak uterine contractions, incorrect positioning of baby, psychological factors (such as worry, stress, or fear), and certain pain medications are also on their list of things that can contribute to slow or stalled progress.

The truth is, labor is unpredictable and every birth unfolds differently. There’s a lot that you simply can’t control when it comes to your birth experience.

But you can inform yourself of your options, choose a provider that you trust, and surround yourself with people who support you.


And there’s certainly a lot of power in that, isn’t there?



Elizabeth Gomez