Midwives: What Is Considered Failure To Progress? - Mothering Forums

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Old 05-26-2011, 05:24 PM - Thread Starter
 
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In hospital labors so many c sections are accredited to FTP. What is the real deal regarding failure to progress? I mean if a woman hasn't had any cervical change within so many hours but the baby isn't distressed why would a cs be needed?
I'm debating between a second homebirth (1st one didn't go well) or a hospital birth. And want to be well educated to prevent UNnecessary c sections. The dr I'm considering is very natural birth friendly so hopefully I won't have any trouble.
Any facts or knowledge you can provide on the subject would be greatly appreciated.

How does this relate to dr's saying the baby isn't dropping/ entering the pelvic cavity?

Could ALL of this be greatly avoided by NOT be allowing induction, waiting for labor to occur sponateously & laboring at home as long as possible- hopefully until active labor begins?

Thank you so much
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Old 05-29-2011, 07:27 AM
 
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After mulling over several sarcastic answers I've decided to answer more directly:

Failure to progress is defined by the person who calls the c/section. I'm sure there are institutions that have specific numbers loosely based on Friedman's curve, but in the end it's all about the specific OB. 

 

Lack of progress in and of itself is never going to kill anyone - it's the sequelae that will. So no, a c/section isn't necessarily "needed" just because someone hasn't dilated at all (or "enough") after a certain number of hours. Fetal distress will eventually follow if no change is made and so can a whole host of other issues. I think the question is: is it safe to wait if the most likely outcome is complication rather than more dilation? Since we never know which is more likely, I don't think it can be answered.

 

Perhaps your other questions are best answered in your DDC.


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Old 05-29-2011, 09:46 PM - Thread Starter
 
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thank you sarah for your answer and for NOT replying sarcastically :) As I obviously know what FTP IS, but your answer is more what I was looking for. Why it is recommended when mom & baby are perfectly fine and the the more important question, can you decline or hold off on the c section and what is the risk if you opt to wait. Thanks again for your answer.

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Old 05-29-2011, 10:50 PM
 
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I want to second the thanks for the well thought out reply Sarah! I was wondering the same thing as currently this is the only thing my midwife has mentioned as a possible complication. :P Just due to this being my first time. So I'm praying that our little girl co-operates and that's not the case! I really appreciate the question as well and am following the thread to see what else is mentioned if anything. :) 


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Old 05-30-2011, 01:22 AM - Thread Starter
 
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Bobbinbopbop- I don't want to put any doubt in your mind about hb as most go fine. But FTP is NOT the only complication that can occur. I had to learn this first hand & it is NOT the "magical" experience hb is painted out to be if things don't go perfectly. A few very common complications are: asynclitic positioning, shoulder dystosia, postpartum hemorrhaging, neonatal respiratory distress. The list really goes on. While I'm not against hb at all, I can't say I'm quite willing to take the risk a second time. If you have any questions or want to chat about hb for first baby you can message me. I also have 3 sil who have had homebirths so been around it some. Best of luck to you!!
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Old 05-30-2011, 04:09 AM
 
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Kr_mom is right that there are many potential complications that can happen at any birth, home or hospital. But I would like to point out that they are in fact quite uncommon. The vast majority of births are uncomplicated.

 

Bobbinbopbop, it could be that your midwife only mentioned ftp because that is the only common complication she would like to transfer for. Most likely (hopefully, if she's competent! you might want to ask her how she would deal with various complications) she could deal with a shoulder dystocia, neonatal resuscitation, pp hemorrhage, and malpositioning at home. However, if you are just laboring and laboring and making no progress and you're getting exhausted/the baby is not doing well then that would be something she could not deal with at home and she would suggest a transfer to the hospital.

 

As for the original post, yes, it does very much depend on the care provider. I think your ideas about waiting until labor is well established, etc. are good for helping to prevent a diagnosis of ftp in the hospital if you decide to go that route. Also, for positioning, have you checked out spinningbabies.com? It has a lot of info on positioning and exercises that are supposed to help the baby get in a good position for going through the pelvis. Could be worth a look anyway. 

 

ETA: Oops, sorry not a midwife. Just noticed which forum this was in.


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Old 05-30-2011, 09:35 AM
 
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Thanks all! I know there are a lot of things that can go wrong. This is just the biggest fear for me as it's so vauge and uncontrollable. 


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Old 05-30-2011, 04:48 PM - Thread Starter
 
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From experience I think it ALL comes down to your care provider, hospital or home. Yes, a competent midwife should be able to handle many complications but my sil almost lost her baby and she had a very competent midwife. Which is probably the ONLY reason she didn't lose the baby. If she of had my midwife, things would have ended tragically. I'm sure all mommies on here are realize complications can occur go wrong at home or the hospital. I guess I am just starting to feel like if a true emergency did arise, I would want numerous people available to care for baby & me, technology, medicine, and doctors to be just a snap away if needed. 

ursusarctos- I will look into spinning babies.com but I did do hundreds of pelvic tilts every night along with other things that were suppose to help baby engage in proper position, but it didn't work. I did also have my water broken by midwife at 5cm and I have read PROM can sometimes lead to asynclitic positioning. 

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Old 06-06-2011, 09:42 AM
 
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FTP is failure to wait in most cases and often that means failure to wait for real labor.  Inductions are so common that it seems to have slipped our minds that they fail a large portion of the time.  It's difficult to make the body give birth if the baby isn't ready.  I really hate that 'diagnosis' when used to justify a c-section because it's so rarely true. Yes, you are correct that induction is a primary cause for this issue.  The c-section rate skyrockets with induction and it's not just due to the cascade of interventions (extra pain = epidural = slower contractions = more pit = fetal distress) but it's also often due to the labor not getting anywhere because the mom was never in real labor.

 

Another reason for failure to wait is those cases where it is a normal labor pattern *for that woman* due to a variety of factors, but it is not within their acceptable limits.  In these cases, it is not usually immediate risk to the mom or baby that motivates the c-section, it is fear of liability should something happen and they were seen to be doing 'nothing'.  In our court system, taking action is always seen as more responsible than not taking action, regardless of the risks from that action.  I think this idea is deeply rooted in our male-centric, medical system which views the female body as abnormal and as inferior incubators because they cannot be controlled.  Regardless of the reason, however, c-sections are the gold standard of responsible care.  Let me be clear that this is not because they are safer.  C-sections carry significantly  more risk for the mother than vaginal birth (about 4 times the risk of death) and a host of other issues for the baby not to delve into the long term consequences of motherbaby separation, breastfeeding difficulty, repeat cesareans, and the trauma to the mom.

 

As long as the hormonal balance of the mom's body is not being disrupted (this requires her to feel safe, private and unobserved), and she is well nourished and hydrated, and baby is handling contractions well, I see no excuse to expose them to the added risk of surgery.  Long labors can be difficult and exhausting, but the truth is that a long labor that started naturally and progresses on it's own time, in which the mom is well cared for and comfortable in her space, is a completely different situation from a long labor that involves prostaglandin gel, water breaking, pit augmentation, epidural, constant fetal ultrasound (heart monitors), and laying in bed on your back.

 

As far as the baby not dropping, the concern is that there is some physical reason for the baby to not descend into the pelvis.  However, it is incredibly rare in the US for a woman to have a pelvis that cannot birth her baby.  The system is just designed too well for that.  Without nutritional deficiencies that warp the bones, or serious injury that has messed up the flexibility or shape, almost every woman can birth the baby she grew.

 

I am speaking in generalities here because that's all you can do with a little information on the internet, but I encourage you to try to find a midwife who trusts birth to work, and who doesn't feel the need to follow strict medical protocols.  Then I would stay home to give birth.

 

If you don't want to consider home birth, I highly encourage you to refuse any kind of induction and wait for true, active labor, before going to the hospital.  I also want to give you hope.  The rate of vaginal birth success with hospital vbac is pretty high if you actually get to the point of labor (many women are promised a vbac but are pushed into a cesarean or an induction which raises the rate of cesarean at the end of pregnancy regardless of what their Dr. promised them).  In fact it's higher than the chance of vaginal birth overall considering the national cesarean rate.


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Old 06-06-2011, 09:50 AM
 
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Bobbinbopbop - congrats on planning your home birth. I think a first baby is the best time to plan a homebirth!  I hope it goes well for you.  Just remember you were made to give birth :-)  There are other complications that can occur in birth no matter where you have your baby.  However, I suspect your midwife was referring to the most likely cause of transfer.  Most home birth transfers to the hospital are not due to emergency situations, they are due to long labors.  The midwife's beliefs about birth and protocols have a lot to do with how she handles these labors.  Some midwives transfer a lot sooner than others.  For me, I don't consider it my decision.  I give mom and family all the facts, and unless I see an immediate life-threatening risk to them (in which case I have already called an ambulance) I respect the decisions of the parents.  I don't think anyone is more qualified to make these choices than the mom herself.


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Old 06-06-2011, 06:35 PM
 
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Thanks! I think your info was great and it really sets my mind at ease. We learned about rest and re-alignment in birth class a few weeks ago and tht made me feel a bit better to. Knowledge really is power! 
 

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Originally Posted by Sijae View Post

 

 

 

Bobbinbopbop - congrats on planning your home birth. I think a first baby is the best time to plan a homebirth!  I hope it goes well for you.  Just remember you were made to give birth :-)  There are other complications that can occur in birth no matter where you have your baby.  However, I suspect your midwife was referring to the most likely cause of transfer.  Most home birth transfers to the hospital are not due to emergency situations, they are due to long labors.  The midwife's beliefs about birth and protocols have a lot to do with how she handles these labors.  Some midwives transfer a lot sooner than others.  For me, I don't consider it my decision.  I give mom and family all the facts, and unless I see an immediate life-threatening risk to them (in which case I have already called an ambulance) I respect the decisions of the parents.  I don't think anyone is more qualified to make these choices than the mom herself.



 


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