Failure to Progress or Failure to Be Patient?

I was just reading Waiting 2 Hours Can Prevent a Cesarean? from Sheridan over at the Enjoy Birth Blog, and I’m being reminded once again that a little patience in labor can go a long way. Sheridan linked up to a great article about a 2008 UCSF study that showed how waiting an additional 2 hours after “stalled labor” had been diagnosed allowed one-third of women who would have had a c-section to go on to a vaginal delivery! Check out this excerpt from the article:

“While ACOG already recommends waiting at least two hours with adequate contractions in the setting of no progress in active labor, it is routine practice in many clinical settings to proceed with a cesarean for ‘lack of progress’ before those ACOG criteria have been met, according to Aaron Caughey, MD, PhD, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, and senior author on the paper.

‘One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year,’ said Caughey, who is affiliated with the UCSF National Center of Excellence in Women’s Health. ‘In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach.’ ”

Now, I don’t want to be a redundant blogger, but I think re-sharing the article is worth it because so many women are told they have failed to progress!

I’ve heard it so many times: “After 3 hours, I hadn’t dialated anymore, so I had to go for a c-section…” “After 14 hours of labor, I was only a 5, so we figured we had to just go with the cesarean…” One woman even told me that she had gone backwards in dialation so she needed a cesarean. I’m not sure if that’s even possible, but I think it may have been due to inaccuracy of the nurses’ estimations of dialation (maybe the first nurse said a little bigger, or the second nurse estimated a little smaller).

Another woman I knew “stalled” after her transition period, before pushing. No one had told her that this is actually a fairly normal occurance, and that it should really be viewed as a nice little break for her body. She panicked, thinking her labor was going to take forever, and decided to get an epidural (despite her strong wishes for a natural birth). She went on to a vaginal delivery, but felt very disappointed over her labor and birth experience.

Stalled or slow labor is normal. As long as mom and baby are doing fine, using natural means to progress labor (Check out Sheridan’s post for more links on this topic) and having a little patience can make a big difference for many moms. Of course, for some, a cesarean is necessary for true lack of progress, and no mom should  be made to feel at fault if she had one in any case. I just think that those doctors who are hasty should perhaps slow down a bit, follow their own ACOG guidelines, and wait to see if mom progresses before making the cut.

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5 responses to this post.

  1. Thanks for sharing my post. I so agree that this is information that needs to get out there to ALL moms. If everyone knew this, cesarean rates would go down.

    Reply

  2. I know that when i delivered my son ( 29 years ago ) my doctor sent me down first for a pelvic x-ray and all was a go (meaning he would fit through my pelvic region ) so we waited and waited and then after quite some time ( an entire day ) my wonderful son was born complication free ……I really did have a great doctor !!!!….But then again people back then were not sue -happy either …..Great information miss abi …..keep up the great work here …..Great church service message wasn’t it ? …..Enjoy your (snowy ) day.

    Reply

  3. I’d love to see how many cesareans would be avoided if they would wait 4 hours, or 6 hours, or (gasp) even 8 hours! In my first labor I went VERY slowly…from when I felt my first contractions until I was 9 cms was about around 28 hours. It was another 6-7 hours before I got to complete…but I only pushed for 20 minutes before birthing vaginally.

    Yes, it is possible to have reverse dilation. It can happen as you speculated–different people doing measurements. But it can also happen after the water breaks if the forewaters were holding the cervix open, if the baby shifts position, or if the mom feels unsafe.

    Reply

    • I very much agree! I think as long as mom and baby are doing fine, there’s no reason to feel pressured to do a cesarean. My mom had about 24 hour labors with both my sister and I, and I was actually surprised mine was only 14! 🙂 I pretty much expected it would take a while to progress, especially with my first.
      Thanks for letting me know about the dialation. That makes sense! I’m always looking forward to learning about things like that. Thanks for stopping by!

      Reply

  4. […] (It could just as easily be called “failure to progress”-or as I prefer to call it, “failure to be patient.”-an equally unsatisfying reason for a C-section in many cases…) If you missed it and would […]

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