Failure to Progress: A New ICAN Video Project

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The first hit in a Google Search for the term “Failure to Progress” is an article of the same name posted at Pregnancy.org, which notes that the diagnosis of labor dystocia is fairly arbitrary and varies highly from hospital to hospital, as “some doctors and patients can be too quick to abandon plans for a vaginal delivery.” For reasons detailed in the excerpt below, many consider “Failure to Progress” to be a failure of the doctor to wait.

Maybe the problem lies not with the women diagnosed with dystocia but with how doctors define the term. Women today are held to a half-century-old labor standard called the Friedman curve, one of the first things obstetrics students learn in their training.

Emanuel Friedman wasn’t yet 30 when he plotted the eponymous scale in 1953, during his residency training in obstetrics and gynecology in New York. Friedman found that, on average, it took 2½ hours for the cervix to dilate from 4 to 10 centimeters.

“In the last 50 years, the Friedman curve pretty much dictated obstetric practice, at least in the United States,” says Jun Zhang, an epidemiologist at the National Institute for Child Health and Human Development.

Several reports suggest that many cesareans performed for dystocia might be unnecessary. When labor appears to be stalled, doctors — as well as patients — often give up too quickly and move on to a C-section.

For example, a study of deliveries at 30 Los Angeles and Iowa hospitals found that about one-quarter of women who had cesareans for lack of progress were only in the very first phase of labor, called the latent phase, when the procedure was performed. Some hadn’t begun to dilate.

That doesn’t square with the American College of Obstetricians and Gynecologists’ definition of dystocia: no dilation of the cervix and no descent of the baby for at least two hours during active labor.

Maybe, the Los Angeles and Iowa researchers suggest, doctors have become so comfortable performing C-sections that they’ve relaxed their definition of lack of progress in labor.

One of the results of this mass over-diagnosis of labor dystocia is that many women are left feeling inadequate about their bodies, telling friends “I’m just not good at birth” or “My babies just don’t descend on their own” or “My labors just don’t keep going on their own without Pitocin.” While it may be true in some cases and I refrain from passing judgment about individual situations, I remain highly skeptical that labor dystocia is the epidemic that obstetricians are making it out to be by operating so frequently.

 

The International Cesarean Awareness Network must be skeptical, too.

 

ICAN’s next education project is the production of a video about women who overcame a diagnosis of “Failure to Progress”. They are looking for women who were diagnosed with “Failure to Progress” (FTP) as a reason for your cesarean, and who subsequently had:

  • a fast birth, contrary to a care provider saying something akin to “your body just will NEVER dilate past X cm”
  • OR had another long labor, going past the time or dilation “stall” of the previous “FTP” but then kept going and had your VBAC, showing that all that was needed was patience for a body that liked to go slow

If you have a story that falls into the above categories, please email to youtube@ican-online.org the following things:

  1. a very short summary of the two births, including any pertinent quotes like “doc said my body just wouldn’t dilate past a 4…” or “I gave up because after 24 hours at 5 cm I was told I’d never progress…” and then the next birth “another 24 hours at 5 cm but then I went from 5 cm to 10 in 20 minutes!” or similar stories.  If you did anything DIFFERENT (changed care provider, didn’t have dilation checked, hired a doula, read X book, or anything else relevant, etc.), please include that information, too.
  2. TWO pictures from each birth.  They would like to have one “labor” and one “birth” picture from each.
  3. Your name, contact phone number or email.  They will send you a release form to sign once they receive your submission and might follow up with questions about your story. Please remember to use the email address youtube@ican-online.org

 

Personally, I would like to hear from all of the women (or witnessing birth workers) who have ever had to beg for more time in labor, imploring their doctor to just give them just thirty more minutes or one more hour to push out their baby. In the absence of any fetal distress or risk to the mother, recommending unnecessary surgery is an inhumane practice and women and their partners should not be begging for permission to allow a physiological process to continue on its own to completion.

 

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