Failure to Progress or Failure to Wait?

As a doula, I’ve had the privilege of attending many different births. I’ve been to hospital births with epidurals and episiotomies, birth center births with OP babies, and even a home birth where the midwife didn’t make it on time (my first catch!). Each birth has been beautiful and unique to the family that I serve. But I have noticed an alarming trend over the years that needs to be talked about: Our cesarean rate in the USA has reached over 32% of all births. While there are reasons that make cesarean birth the best choice for both mom and baby, many times they could be prevented. The leading cause of cesareans is “failure to progress.” Let’s look into what that means and the factors that can contribute to or help prevent this from happening.

“Failure to progress” is when a healthcare provider decides that labor is taking too long. It is largely subjective and can depend on the patience level of the provider. This term could describe prolonged dilation or slow pushing. Maybe the baby is taking a long time to descend or is malpositioned. These factors alone do not indicate a cesarean, yet failure to progress is the leading cause of cesarean sections, with up to 55% of these surgeries due to failure to progress. With in-home births, only 4% of transfers to the hospital were due to this. 

Many factors could contribute to a lengthy labor including a medical induction, being a first-time mom, being confined to bed in labor, having an epidural, dehydration, or a malpositioned baby. Some factors that might shorten labor are laboring in upright positions, hiring a doula, being allowed to move freely in labor, eating and drinking at will, and not having an epidural. It’s important to note that while these factors can contribute to lengthy or shortened labor, this is not always the case. Having an epidural does not guarantee you will have a prolonged labor. But having an epidural along with declining a non-medical reason for induction, hiring a doula, freedom to eat and drink, and position changes can greatly increase your chances of achieving a successful vaginal birth. 

It is helpful to know your provider’s policies for prolonged labor. Talk to them ahead of time to find out their rate of cesareans. Do they practice routine inductions without a medical indication? What is their policy if you have a prolonged dilation stage? Get informed to be able to make the best decisions for your care. Stay at home as long as you can during your early labor. This can also greatly reduce the chance that you will be labeled as a “failure to progress.” Some women genuinely have a labor that does not progress for some reason or another. There is no shame in that. If your body and your baby need some extra help, then great! That’s what medical intervention is there for. But the vast majority of the time, “failure to progress” should actually be deemed “failure to wait.” Be patient with yourself, your baby, and the process, and find a provider who is willing to wait expectantly with you!

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