9 Things that can lead to Failure to Progress (FTP)

woman-in-labourWhat is Failure to Progress? According to doctors and midwives, Failure to Progress is also known as Prolonged Labour, when labour lasts for approximately 20 hours or more after regular contractions begin, and approximately 14 hours or more if you’ve given birth previously. Prolonged latent phase happens during first stage labour where mother can get exhausted and emotionally drained, and prolonged labour during second stage can be a “cause for concern.”

According to WebMD, Prolonged labour may happen if:

  • The baby is very big and cannot move through the birth canal. (Cephalopelvic disproportion)
  • The baby is in an abnormal position. Normally, the baby is head-down facing your back. (Posterior presentation: back-to-back)
  • The birth canal is too small for the baby to move through. (Android pelvis, narrow pelvis)
  • Your contractions are very weak. (Inefficient contractions)

NOW HERE’S the HARD PART. Scratch everything that I just stated up there and everything that you hear from doctors and midwives. Remember, they’re a part of a system, either hospital, birth centre, or NHS and they need to be able to put mothers on a schedule, a timeline, and checklist, so they can do their job. They can’t wait around for days for mums to give birth naturally, so they need a cut-off point where they can say “It’s time to get your baby out, we’re prepping you for a c-section.” FAILURE TO PROGRESS IS NOT CAUSE FOR A C-SECTION. In some rare cases, Cephalopelvic Disproportion (which has an incidence of 1 in 250 women, 0.4%) can lead to a long, unprogressing labour, which will need an emergency c-section. In other cases, women will become so fatigued from a long labour, especially if they also received drugs to induce labour, that they will not have the energy to push the baby out and a c-section will be necessary.

It must be difficult to hear this, especially if you’ve had a previous c-section due to Failure to Progress. Especially since Failure to Progress was the NUMBER ONE reason for a c-section between 2002-2008 in the US. Rebecca Dekker, PhD, RN writes, “In 2013, researchers published a report of 38,484 first-time C-sections that occurred among a national sample of women. The overall C-section rate among first-time mothers was 30.8%. More than 1 in 3 (35%) of these Cesareans were due to a diagnosis of “failure to progress,” or slow progress in labour.

This means that 10%, or 1 in 10, of all first-time mothers in the U.S. had a Cesarean for failure to progress during the years 2002-2008 (Boyle, Reddy et al. 2013).”

So if Failure to Progress isn’t a real problem, what’s happening in the body to cause long labour? Every woman is different. The main reason why you may be having a long labour is because you are completely healthy and normal. You’ve done an amazing job eating a high protein diet, you’ve exercised daily and are fully informed regarding birth. You know that you can trust your body and your baby’s just taking his time moving into the right position. Unfortunately, it’s the midwives, doctors and nurses who don’t want to wait for your baby to progress naturally. They don’t have the time to wait around and decide to push labour along with drugs or start suggesting a c-section. THIS IS NOT THE KIND OF SUPPORT MOTHERS WANT OR NEED.

There are also many other factors that attribute to how labour progresses, whether fast or slow, whether unbearably painful or bearably painful (I haven’t met a mum who didn’t say it hurt). Here are some factors that may attribute to a long labour (past their approximate 20 hours of unprogressing labour):

1. Inducing Labour. You were given drugs to start labour rather than waiting for spontaneous labour to occur. Your baby might not be ready to come out, so your baby hasn’t released oxytocin to your uterus to start contractions. Therefore, the synthetic version of oxytocin (pitocin or syntocinon) is given to the mother; however, this synthetic version doesn’t cause labour to start like it would naturally. Sometimes, labour doesn’t start at all; sometimes, contractions are extremely painful, long, and have in some instances, killed the baby. What midwives and doctors don’t seem to realise is that just because they introduce syntocinon doesn’t mean the body or baby is quite ready. This can lead to long labour, since your uterus may be contracting, but nothing else is happening because the baby isn’t ready to come out yet! (Also, see what’s wrong with the 40-week due date).

2. Poor Nutrition. It’s hard to believe, but poor nutrition during pregnancy can have a direct effect on how long labour is. One obvious way is if you are diagnosed with Gestational Diabetes, a form of diabetes that only occurs during pregnancy. The truth is that in American and in the UK, diabetes is a national problem. People do not realise the negative effects sugar and carbohydrates from processed foods have on health. For people who are diagnosed with gestational diabetes, they usually struggle with eating a low-carb diet. Eating many sugars and carbohydrates during pregnancy causes the baby to grow inside the womb at a faster rate than nature intended. Yes, we are altering nature when we eat processed foods. (You can also eat too many sugars with natural foods like fruit, so you still have to be careful what you eat if you’ve gone the organic, whole food way).

Another effect poor nutrition has on labour is lack of energy. Labour and birth is a marathon, it requires months of preparation, watching diet and exercising. When a woman, especially a first time mum, realises her contractions have begun and gets so excited about heading to the hospital or birthing centre, she often forgets to EAT. At the beginning of labour, eating a nutritious meal, high in protein and fat, will help give slow-burning and steady energy in contrast to the fast-burning carbs.

3. Interventions. These come in many forms–IV fluids, epidural, pitocin and syntocinon, hospital procedures, electronic fetal monitoring, vaginal exams. When a midwife or doctor wants to check on you and the baby, they tend to do it in a very intervening way, restricting movement, placing mother into a poor position (lying on her back), restricting access to food and water, and more. These interruptions are usually not short interruptions, often lasting hours! Good midwives are able to monitor baby and mum without restricting the mother to move about and to eat and drink. I’m going to get more specific about this interventions in a moment.

4. Lying on her back. First of all, this position for mother is dangerous to mother and baby from about 25 weeks of pregnancy and onwards! The weight of the baby inside the womb presses upon a large vein inside the mother that impedes blood flow to the mother, and as a result, to the baby. Second of all, this position for second stage pushing is the worst idea ever. Doctors invented this birthing position for the sole purpose of CONVENIENCE. Otherwise, they would have to crouch down or use a flashlight to see what was going on down there. As you can see in this video, the birthing canal opens by at least 10% for the baby’s head to fit through (1:28).

Ignore the fact that this is advertising a product, but I think it shows an excellent illustration of the opening of the pelvis and coccyx bone at 1:28.

5. Restricting Movement. As mentioned in #2, receiving IV fluids, epidural, having Electronic Fetal Monitoring, and other hospital procedures may prevent you from movement. In the movies, you’ll often see mothers lying in the hospital bed, screaming through her contractions, and just ‘wishing’ for her baby to come out. Most mothers who get the epidural cannot feel their legs, let alone walk and move around! To aid in the labour process, ensure that you will be able to walk, ‘labour dance,’ squat, get on hands and knees, and listen to your body. All of these are excellent positions to help the baby align itself within the birth canal. Especially if you are in an upright position, you’ll also have gravity helping the baby come out naturally!

6. Restricting Food and Water. You don’t need IV fluids during pregnancy if you just want water available to you during labour. In fact, drinking when you’re thirsty is a more accurate way of replenishing fluids than being hooked up an IV (where you will get too many fluids, which can bloat the mother and baby). Eating will help give energy and being able to eat will reduce stress. Some hospitals do not allow mothers to eat or drink because of the risk of choking on food during a possible emergency c-section. This hospital policy is antiquated and needs to be done away with.

7. Stress. Most mothers who give birth naturally outside of the hospital give birth between 1:00am and 6:00am! This study compared hospital birth times and non-hospital births. Why do you think that is? It is the most relaxing time of the day where you are settled to sleep, work is over, the house is silent, the other members of the house are asleep, and you can get to the business of birthing without added stress. Mothers who start labour during the day and enter the hospital for their birth often find themselves stressed out or uncomfortable. This can lead to the body not wanting to open up, the pelvis being rigid because stress is preventing the body from releasing hormones that would relax the ligaments, which will lead to a long labour. Sometimes, an epidural can help in these situations to relax the mother, ease the pain a little, and then stress will be reduced, allowing labour to progress. Just know that you’ll most likely be limited in mobility and movement due to an epidural. See this funny video showing stress causing “FTP.”

8. Drugs that induce or speed up labour. When mothers are ‘failing to progress,’ midwives and doctors ‘help’ mothers by offering them syntocinon (pitocin in the US) or other labour-inducing drugs. These drugs cause labour contractions to be harder, stronger, and longer than normal natural contractions. They make labouring much more painful and then usually require an epidural or numbing drug. Not to mention it being more painful (and then more stressful) for the mother, the drugs also impact the baby harder and for longer periods of time, reducing the amount of blood flow and oxygen that the baby receives whilst within the womb. The introduction of these kinds of drugs usually usher in the “need” for the c-section. There was a recent study claiming that inducing reduces the need for a c-section, and you can read my rebuttal here.

9. Lack of Knowledge. Have you ever heard of the Natural Alignment Plateau (N.A.P)? This is a period of time where dilation may ‘stall’ whilst contractions keep going. Sometimes, contractions stop altogether. What you need to know is that it’s a natural process in which the baby and mother are working together during labour and birth. Sometimes the cervix stops dilating because the baby needs to change position and the contractions are helping the baby adjust in the womb. Other times, it’s because the mother is tired and just needs to rest before continuing baby’s descent and/ore pushing baby out. This period of time is usually the opportunity midwives and doctors use to label her with Failure to Progress, or Prolonged Labour, and this is often when Syntoconin is introduced. Sometimes, mums move forward with the drugs, or consent to the c-section just because they DIDN’T KNOW about the N.A.P!

Did you know that your pelvis widens and baby’s head molds and shapes? True CPD is very rare, and unfortunately, many women are told they had CPD for doctors to justify their cause for c-section. This is especially true for VBAC mothers who had larger babies vaginally after their first c-section for their smaller baby! Check out the Truth about CPD by BellyBelly.com.

This is when it is so important to take a Bradley Class. We live in an age where mothers don’t know what birth looks like until it happens to them, wisdom is no longer passed down through mothers and grandmothers attending births within the family and community.

In conclusion, Failure to Progress isn’t a real diagnosis, condition, or a cause for a c-section. CPD and fatigue may be reasons to have a c-section, especially if baby’s vitals are failing. If you have fatigue and are given the option to have labour induced, you can decline it and take a nap, eat something, drink some water, and then get on with birthing vaginally. If you’ve already gotten to the point where you’re too exhausted and cannot rest or reenergise, you may want to consider a c-section (especially if baby’s vitals are failing)!

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