Obstetric Lie #100 – Failure To Progress


(Contributed by Sarah Clark)


Failure to progress.


Oft named as a reason for cesarean. Oft mentioned to the supine mom in the hospital as she is encouraged to get her epidural and “relax”. By the naysayers in the natural birth community, it is often renamed, Failure to be Patient or just, “Doc must leave to make his golf game.”


Whatever it means to you, the term failure to progress is both powerful, disturbing, and strongly indicates not just lack of ability but complete and utter physical failure on the part of the mother. Personally, I would love to see this phrase just disappear from our culture all together. And so, in an effort to trash this phrase for once and for all, lets take a closer look at it.


The Vaginal Exam


Ahh yes, you can not actually talk about the term “failure to progress” without first discussing the vaginal exam. Though the VE can give you plenty of useful information, it can not in fact tell you when you are going to actually HAVE YOUR BABY.


If you learn nothing today, learn this: Nobody will know how you are progressing, if nobody puts their hands in your vagina. If you don’t want to be diagnosed as a failure, simply remove the test that does the diagnosing. You do not need a vaginal exam to have a baby.


I am serious.


They will still come out.


So, one first step to eliminating the term, “failure to progress” is to eliminate the routine vaginal exam. The truth is, a woman can be dilated to a five for a month and have her baby at 40 weeks. A woman can also be dilated to a five and have her baby 10 minutes later. The body does not listen to textbooks. Especially textbooks that say you must dilate one centimeter an hour once you hit active labor.


Like a baby, your body has no idea how it should act in order to ensure a textbook medical labor. Leave it alone.


Understanding Birth


The truth is this- science can not totally understand, quantify or write books about birth. You can take all measurable things and put them together and still not KNOW when a woman should have her baby.


Can we understand birth? On an instinctual and female level, yes. On a scientific level, no.


Birth is not science. It involves head, emotions, body, place, fear, expectation, and much more. Now lets assume you are getting vaginal exams and your body does “stick” or “fail” at a certain point of dilation.


What Happens During Birth?


As a birthing woman I believe there is much more going on here than simple measurements. A woman who is stuck at a six for hours on end is not a failure. Is the baby healthy? Is mother healthy? If the answer is yes to these questions then plenty could be happening that we can’t see or feel. You are taking a huge step into an unknown realm. I think this is part of the reason why the first labor is often the longest. It is not just the first time our body is doing this, it is the first time our brain and our spirit are doing this too. (Even if it not your first child, it is still the first time you are birthing THIS child.)


Maybe you fear something. Maybe you have to let go of something. Maybe you have to say goodbye to something. What could this “something” be?


Closing a chapter and opening a new one on your relationship with your lover. Letting go of fears about becoming a mother. Letting go of fear and hurt and abuse and worry. Letting go of or working through past birth trauma.


You are not failing, you are learning.


But birth is not just emotional either. It is also physical. Things can be happening in the body that we can’t see either. Bones and ligaments are moving and stretching. The baby is being massaged as he comes down the birth canal. Your body is preparing colostrum for that first feeding. The baby is turning and finding his best way out. Your body should be moving with him and helping him.


Being strapped down and getting medicated or cut open is not necessarily the answer. You are not failing, you are preparing.


Patience, Young Skywalker


If it takes time to become a Jedi, then I think it is safe to say that it takes time to become a mother. Why don’t most babies just fly out?


Your body births with all the accompanying signs and feelings and sensations in order to prepare you for motherhood. Motherhood is a big deal. It takes time to prepare for it. Let it take its time. Stay where you feel comfortable laboring as long as you need too.


If you get to your birth place and you are not very dilated and not showing signs of very active labor, go home. Don’t feel like a failure about it.


It is OK.


You are excited to be on the journey. Studies have shown that c-section rates are high in part to simple lack of patience. Talk to your care provider.


Ask questions. “How long can I be in active labor before you start to worry?” “Can I avoid vaginal exams?” “If mom and baby are fine, can I labor as long as I would like?”


So how do you avoid failure to progress? First, don’t assume that the vaginal exam will tell you if you are progressing. If that is how we measure the pass/fail in childbirth, then I for one am scared to take that test. (It is always a bad sign when the person handing out the grades puts on a glove and asks you to spread your legs.)


Second, don’t assume that staying in a certain spot dilation wise indicates failure. There is a lot we don’t understand about birth. And there is a lot more to birth than what we can measure.


Then, be patient yourself. It isn’t just up to your doctor to trust birth. It is up to YOU. Let your baby come when it is ready. An induced, undercooked baby may simply not want to come out yet. They can get it out. But not the way it normally comes.


Let your labor start on its own, and then let it proceed on its own. Stay mobile. Your body wants to move that baby down and out.


Be logical. What positions assist that and what positions work against that? Lastly, be aware of your own emotions and fears. What are they? What can you do about them? Could they effect your labor? Are you willing to face them and deal with them?


Oh wait- I forgot one! Don’t get an epidural! Sometimes they cause no problem. But many a woman has had trouble with failure only AFTER the administration of drug that numbs half your body. Who would have thought?


Do some women have to have their babies via c-section? Of course. But your body is not a failure and it is not broken. It works. I am willing to bet that not only is your body perfectly capable of opening and having a baby, it is more capable of doing that than 100% of the male Ob’s out there.


(Because of course, they don’t even have vagina’s…)



About Sarah Clark

Sarah Clark is a mother of four, a natural birth blogger, a natural birth teacher, a board member for Birth Boot Camp (a company specializing in online natural birth classes) and a wife.  Her first labor lasted about three days and she never failed to progress.  She has written about 20 Obstetric Lie posts on her blog and you can read them there.  This was the first.  

9 thoughts on “Obstetric Lie #100 – Failure To Progress”

  1. It’s all very well to say all of the above, but your dramatic comment “Don’t get an epidural” is over the top and inaccurate, in my experience. I laboured for three days after being induced at 43 weeks. While I agree with you that induction is not a great idea, there comes a point where there may be very few alternatives, bearing the best interests of an unborn child in mind. For me, it was ONLY upon receiving an epidural that my labour progressed. While I had hoped and planned for a non-intervention birth, that wasn’t to be. I think that articles like yours tend to set the birthing scene up as an “us vs. them” situation where doctors are these evil interveners and the mother can just do everything if she just puts her mind to it. That mindset happily ignores the numerous losses of babies and women in childbirth prior to the increased availability of medical interventions. I have read statistics that in the late 1800s, 40-60 deaths of women per 1000 births is a likely figure in Britain, while today 20 per 100,000 is considered high. While no interventions might be ideal, this dreamy sort of thinking tends to set a lot of new mothers up for feeling like failures if they need intervention to save themselves or the baby. Maybe I could have demanded more time before agreeing to an induction, but I don’t consider myself a failure, even though that’s the message I receive from your article.

  2. @manysplinters – I don’t think the author was trying to say that you are a failure for using interventions. It seems more like you had a different experience than the one you had originally set out to have, and I’m very sorry to read the pain in your words. I hope that you can make peace with the birth experience you did have. Interventions are there for when they’re needed, and no one wants moms to feel like failures for using necessary help.
    In the past, mothers died from lack of medical help. Today, mothers die (and experience other serious complications) from too much intervention. We’re in a different situation than 150 years ago – but it’s not better.
    The fact is that for most women, the safest course is to avoid doing unnecessary things that alter the body’s normal processes. Can an epidural help a mother relax enough to ‘progress’ somewhat? Yes. But so can a safe and familiar environment, an understanding that the body is designed to give birth, and a situation that is free from institutional demands to “progress” according to a schedule. That’s not dreamy, that’s what the evidence shows to be best for moms and babies.
    It makes no sense whatsoever to do things that completely oppose the body’s normal processes, then act surprised and offended when those processes then don’t work. Sadly that’s our current birth culture. And moms bear the blame for it.

  3. want to see something neat?? look at animals who have multiple babies they dilate begin giving birth and some take breaks for hours between babies.
    They have proven that rates of c-sections due to “failure to progress” occur most often at 4 pm and 10 pm. doctors who don’t want to be late for dinner and those who don’t want to be waiting around into the wee hours of the morning. As well as the co-relation of epidurals and intervention methods and c-section.
    look up the statistics for problems with epidural:
    Catheter misplaced into a vein (uncommon, less than 1 in 300). Occasionally the catheter may be misplaced into an epidural vein, which results in all the anaesthetic being injected intravenously, where it can cause seizures or cardiac arrest in large doses (about 1 in 10,000 insertions).
    Neurological injury lasting less than 1 year (rare, about 1 in 6,700)
    Epidural abscess formation (about 1 in 145,000).[43] Infection risk increases with the duration catheters are left in place, although infection was still uncommon after an average of 3 to 5 days’ duration
    Death (less than 1 in 100,000)
    death more common then infection… hmmmmmmm……
    and that’s only a small fraction of complications…

  4. Okay I have a question someone might be able to help me with. After three natural births this time I am diabetic and my midwife turned my care over to an OB she turst. I have been told most likely they will want to induce me at 39 weeks. I am doing every thing in my power to keep my blood sugars down but now am getting ultra sounds every four weeks to messure the babies growth when at 22 weeks I messured 24 weeks and now at 24 weeks i am messureing 29 weeks (baby is messureing 26 weeks) They are very worried about his growth tomorrow I am getting a diffrent ultra sound an hour long look at his heart 🙁 So i am pretty sure it will be suggested to induce I am scared about it my natural labors never hurt much and were fairly easy I am only 25 weeks now so i have another 14 weeks till they will want to induce but the whole thing is worrying me. What if they don’t let me get up walk around and move. what if they don’t let me eat or drink what if they want to hook me up to all these wires and cords and stuff? WHAT IF THEY WANT TO DO A C SECTION. I really need help from someone who can tell me what kind of questions to ask and what to do to make sure I have to best chance at an as natural labor as i can have.

  5. I am sure that each birth is unique, and that labor usually progresses more naturally when women feel safe, and when they are free to move around. However, I find myself annoyed at the all-out slams on science, such as the statement that we cannot understand birth on a scientific level. Of course, scientists have studied the birth process, and have learned a great deal from that endeavor. I, for one, am tired of the either/or thinking that says we have to be either pro-science or pro-nature and pro-intuition. How limiting! Women can be strong, feminine, intuitive, nature-lovers who also love logic, math, and science!

  6. Jackieg414, if you are delivering in a hospital in the us, you absolutely will not be allowed any food or drink once induced. Whether or not you will be able to move depends on the specific circumstances, but pitosin contractions are much stronger than natural contractions, and if you end up needing an epidural you will be confined to a bed. I wanted to have a completely natural birth with my first, and i ended up having every intervention along the way including a c-section. Mine was not a traditional ftp, i did push for 4 hours, and my son just wasn’t moving down the birth canal. While i was disappointed with the process, and definitely felt like a failure with the c-section, after 36 hours of labor i just wanted it to be over, and in the end the most important thing is that you and your baby are happy and healthy. I can honestly say that my c-section went beautifully, and while i hope to never have another, i don’t feel my recovery was any more difficult or uncomfortable than a recovery from a traditional vaginal birth. So, what i’m saying, if it helps, is that while i would not choose to be induced and deliver in a hospital (currently pregnant with #2 and hoping for a home birth this time) if there is a medical reason for it, and a midwife you trust has referred you to an ob she trusts, it may well be a different and much less beautiful experience than what you had in the past, but in the end your baby will be just as perfect, just as beautiful, and you will be happy that you are both healthy!

  7. I have to disagree somewhat on this. I had a homebirth with NO interventions. My midwife did a vag exam twice and only because I asked her to.
    At 6:18am, 7 hours after my water randomly broke, I asked my midwife to check me; I was 4cm. At 2pm, I was still at 4cm, so I had my midwife “stretch” me. I gave birth at home at 3:20. And just an FYI, while it hurt like you would not believe, I don’t have any cervical damage.
    I would have ended up with a CSection at a hospital, which would have killed my baby due to 3 doctors (1 of whom HATES homebirths so much he looked for any reason to disqualify you) ALL missed my baby’s Velamentous Cord Insertion. And we wondered why the baby’s heart rate plummeted every time I pushed.
    The VCI wasn’t discovered till I had a manual placenta removal 75 minutes after the baby’s birth. And my backup OB refused to give me antibiotics says “If you’re stupid enough to do a homebirth, you’re stupid enough to get an infection” and this was the PRO-Homebirth doctor!
    What I’m saying is this: Find a provider you trust (OB or midwife, your choice), limit the interventions unless absolutely necessary and enjoy your birth.

  8. Well stated Huntsville Mama! I will add that induction starts the cascading effect. Once one intervention happens, you are much more likely to have more. As a friend of my says, “Going to the hospital to have a baby is like going to a football stadium to play baseball.” You are on their turf and trying to change the rules. Be informed and seek out a care provider that will honor your requests. Hiring a doula is a great resource, too!

  9. I have been part of birth on many different levels and different places on the spectrum. I chose homebirth for my first birth experience. I went to nursing school after that and was horrified to see a perfectly normal labor completely complicated by the poor timing of a doc who asked the mother what kind of ‘pain killer’ she wanted while she was in transition. I then had my second and third births in a hospital birthing center (due to a remarriage to a man with terrible issues from his first child’s birthing) and ran headlong into the controlling arena of ‘SCIENCE’ when my son’s respiratory status was higher than they thought it should be and the fact that he hadn’t passed any meconium within their SCIENTIFIC timeframe. Staff freaked out when my third son’s urethral meatus couldn’t be located by a male resdient who was so uptight about moving my son’s foreskin that he just simply said he couldn’t find it. The midwife came in and voila…there it was. Hospitals are, by and large, not equipped to handle natural birth or the aftermath of a natural birth. They have protocols, care plans, expectations….and if you deviate at all they will, I repeat, WILL intervene. As a young and failry ignorant woman with her first pregnancy, I labored from 10 am one day until the birth at around 4am the next. I was relxed, went about my business and when it was time to settle in I knew it. I was overly excited the second time and my midwife didn’t want to admit me too soon as the birth center was 23 hr short stay. Se we walked and walked and walked. The third time we stupidly did a Key-Stone Cops chase to the hospital and barely made it….after I had almost totally ignored the labor I was having all day. I think when a woman has had a poor experience she feels like she is being condemned for having gone the route of an induction or epidural or had to have a C-section. I just think it’s sad that the hospital protocols don’t allow for lengthy labors and feel the need to place labor in a neat little box. I wish all laboring women could have another, birth-experienced woman with them while they labor to help them relax and flow with the whole labor experience. I think it would go so much better for them. Having said all of that, there are times when science has to intervene. But I’ve seen far too many time when its interventions were the ‘poison’ rather than the ‘cure’. And let’s not forget the SCIENTIFIC STATISTICS our country bears. It’s truly a travesty.

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