There are many different reasons why women have C-sections, and there can even be multiple reasons from each birth.
Some reasons include: having a large baby, baby’s position, fetal distress, infection, failure to progress, multiples, and more.
Today we are going to talk about one of the biggest reasons we hear from our followers and the same reasons in our own operative reports.
What is Failure to Progress?
Failure to progress is determined when a mother’s cervix does not make any change after so many hours.
Historically, evidence has shown that many care providers do not give women the chance to progress in the first stage of labor (dilated to 10cm) or enough time to push the baby out when they do get there.
In 2011, ACOG and SMFM (the Society for Maternal-Fetal Medicine) put out an updated definition on time limits for the first and second stages (the pushing stage) of labor.
The new guideline says that a woman is not considered to be in active labor until six centimeters and cannot be termed as “failure to progress” until she is at least six centimeters dilated, her waters have ruptured, and no cervical change has been made in six hours of labor.
Something that is so important to know is if there is ANY progress at all, that is change. Labor progress is not just about cervical dilation.
Labor progresses through these six stages:
- The cervix moves from posterior to anterior position
- The cervix ripens and softens
- The cervix effaces
- The cervix dilates
- The baby’s head rotates, flexes, and molds
- The baby descends, rotates further, and is born
What Causes Failure to Progress?
Often times when labor has a “stall”, there can be some reasons why, and knowing these reasons can help labor continue to progress on its normal path.
Sometimes when there is an induction, it may be due to a medical reason, or it may be early and desired.
With induction, the body isn’t always ready to begin labor and it can take some time for your body to really realize what it is being asked to do.
Understanding that inductions, especially if it’s early, can take a good amount of hours, and even days.
Water breaking prematurely
Sometimes your bag of waters may break first before labor begins, or sometimes the membranes are ruptured in early labor.
When the bag of waters breaks, it releases hormones that usually kick labor into gear; however, if the membranes rupture first, it can take a long time for the body to register that it’s time to begin labor.
When labor is happening and membranes are ruptured early on, it can bring baby down onto the cervix, but often times in early labor, the baby is still a little higher and that can increase the chances of baby coming down in a wonky position.
Because of this, when water breaks in general, it can start the “time clock.” Providers will watch the time and start to worry about infection after so many hours of membranes rupturing. If labor doesn’t progress “quickly enough”, they may get concerned and push Cesarean for failure to progress.
Poor fetal position
Fetal positioning can play a big impact on the way a cervix changes. If a baby’s head is not on the cervix correctly, it can cause slower or a stall of dilation.
Recognizing the fetal position early on in labor can help labor progress and also ease discomfort like back labor as well.
Failure to wait
Sometimes labor just takes time. It can be protracted by factors like scar tissue on the cervix. Understanding that the woman’s body is not a time clock and doesn’t have to follow exactly when a text book says is vital.
Being patient and letting labor begin on its own is ideal, and once labor begins, allowing and trusting the body to take its own course is best.
Ways to Help Avoid Failure to Progress
Before we leave you today, we want to drop some quick tips for avoiding a Cesarean due to failure to progress:
- Wait it out and trusting the process.
- Hire a doula who is trained in understanding fetal positioning and helping baby rotate.
- Keep moving while you are in labor.
- Have a good provider who will be patient with the labor/birth process.
- Avoid induction unless truly medically necessary.
- Avoid rupturing membranes early on in labor; ESPECIALLY if you’re having signs of a poorly positioned baby.
Tune in to episode 46 of our podcast to hear Rachel’s VBAC after Failure to Progress.
Nervous about your upcoming VBAC? Want to feel informed and confident? Register today for our Ultimate VBAC Course for Parents, and learn everything you need to know before your big day!