Who knew that every woman should follow a fixed time table or risk major surgery? The long marriage of Cesarean section and “failure to progress” are the Don and Betty Draper of the birth world—divorce is a good idea. C-section and failure to progress should follow their example.
“Failure to progress” means a woman’s cervix is taking longer to open than it takes most women. If a woman in labor doesn’t show signs of opening at a rate of about 3 cm per hour, she isn’t “progressing” and needs a C-section to save her and her baby.
But there’s a lot of debate about whether it’s medically correct to expect women to conform to this.
When you plan your birth, ask your healthcare provider what their position is on failure to progress. You can always get a second opinion before writing your birth plan. If you rewrite your birth plan after getting that second opinion, be sure that new plan is on your hospital bag checklist.
WHY ARE C-SECTION AND FAILURE TO PROGRESS LINKED SO TIGHTLY?
In the 1950s, 88% of women gave birth in the hospital. During that time, Dr. Emanuel Friedman developed the famous Friedman’s Curve. His Curve is an artificial time frame for how fast a woman should progress through
- cervical dilation
- baby descent
- length of second stage/pushing
But in his research, Dr. Friedman didn’t separate low-risk births that do best with no interventions from high-risk births that need special management.
More and more health care practitioners consider the Curve outdated, but “failure to progress” is still the standard for many hospital labor measurements and protocols. And, sadly, getting major surgery is the outcome many women face when their body doesn’t match the schedule.
3 GOOD REASONS WHY THAT’S WRONG
- Women are individuals with individual babies who don’t fit consistently into rigid time frames.
- Standards from the 1950s don’t apply to women today. Modern women weigh more, have more induced labors, slower labors, and more medical interventions.
- Researchers recently agreed the definitions of “normal” or “arrested” labor need to change: “The adequate time for each of these stages appears to be longer than traditionally estimated.” 
Active labor means you’re having regular and frequent contractions. With modern women, active labor starts at 6 cm rather than at 3 cm, as was the standard in the 1950s. It can take today’s women 8 hours of active labor to reach 6 cm dilation.
But hospitals that use the 1950’s standard to determine failure to progress (contractions are irregular and the cervix hasn’t dilated sufficiently) don’t wait this long. They commonly give mom a C-section when she’s only at 4-5cm because it’s taken a long time for her to get there.
But by modern standards, this mom hasn’t even entered active labor yet, and could still give birth vaginally.
When touring your hospital, ask if they have heard about the studies that state, “6 is the new 4”. If they answer, “Yes”, you are birthing at a place that practices Evidence-Based Care.
24% OF INDUCED FIRST-TIME MOMS WILL HAVE FAILED INDUCTIONS
Women whose labors are artificially induced with Pitocin or oxytocin don’t always have labors that follow the rules. If their labor doesn’t progress according to 1950’s standards they are likely to have a cesarean, even though mom and baby were doing fine.
An 18 year study showed babies could go into NICU (neonatal intensive care unit) more often after long labors, but there were no differences in their Apgar status, umbilical cord pH, meconium, infection, or birth trauma.
Moms in this study had higher rates of C-sections and uterine infections, but we don’t know how many vaginal exams they had. If you read our post on getting vaginal exams after PROM, you already know every vaginal exam potentially introduces infection.
THESE RESULTS OFTEN DON’T APPLY TO WOMEN WHO GIVE BIRTH OUTSIDE THE HOSPITAL SETTING
Routine protocols at home or in birthing centers are written for low risk women who can often labor longer without interference. Because mom’s unique body, her emotional state, and her mental well being are important factors included in the decision-making process, these women tend to have fewer vaginal exams and medical interventions. Mom has more support and less interference as long as baby’s doing fine.
The term “failure to progress” needs revising because it appears to put blame on women. Many women believe there’s something wrong with how their body and their baby are managing labor. Too many women are being pushed too soon into the operating room for a C-section when what they want is to give birth vaginally.
The birth plan you bring in your hospital bag is subject to individual health changes or conditions, and every birth team only wants the best outcome. Planning your birth with your care provider’s support means your birth preferences will be considered, even when labor doesn’t fit into rigid time schedules.
 Friedman EA 1955, Primigravid labor: a graphicostatistical analysis, Obstetrics and Gynecology, vol. 6, no. 6, pp.567-89.
To learn more about your choices for labor and birth, download our free Birth Plan eBook now. After three years of research, collaboration with more than 100 childbirth experts and resource centers from Healthy Child Healthy World to the American Association of Neonatal Nurses, the Best Ever Baby Birth Plan Guide is available for a free download.
This new resource for pregnant families is a compilation of top tips and advice from more than 20 nationally-recognized experts in the field including renowned pediatrician, Dr. Alan Greene and the GraceFull Birthing founder, midwife Elizabeth Bachner. These trusted experts offer thoughtful guidance for whatever type of birthing experience parents want, in whichever setting they choose.
Published: March 15, 2016 | By SP Turgon, Certified Labor Doula | Reviewed by: Kim Walls, Natural Products Expert, Elizabeth Bachner, LM, CPM, L.Ac., Midwife | Last reviewed: Mar, 2016