Failure to Progress is a leading cause of caesareans. Although contrary to popular belief, Failure to Progress (FTP) isnít a problem on its own. It becomes a problem when either the mother or the baby are showing signs of stress or deteriorating health. So what causes that distress and how can women best protect themselves from the dreaded FTP?
Induction is a leading cause of FTP. The simple way to avoid induction is to keep yourself as healthy as possible and ensure that you are fully informed about the true medical indications for induction. If an induction is recommended you need to ask whether the recommendation is based on your actual health or if it is simply their protocol to induce at a certain gestation. Demand to see evidence that supports induction in your situation. Ask for a Bishop score (a score that determines how likely a successful induction will be). Remember that post dates is NOT a reason to induce, itís a reason to be watchful and act only if something appears to warrant it.
Courtesy of Wikimedia Commons - Stop Watching the Clocks!
Where are you planning to give birth? Did you know that your mammalian brain controls the function of birth and that there are certain conditions that either optimise or hinder it? Animals give birth when they are alone, in a warm, dark space, they drink and eat, and move freely into comfortable positions instinctively. If the venue you plan to give birth in doesnít provide you with these conditions you should reconsider your birth plan very seriously. This might sound like hippy mumbo jumbo but really itís as true as life gets. This is one of the safety features of birth. If a mother doesnít feel safe her body wonít work to give birth. Itís a scientifically proven fact.
Be aware that normal, healthy labour can stop and start. If labour stops itís not a problem, just wait til it starts again. Find a place where you can rest and replenish your body and wait. Of course if there are health problems you can always have labour augmented with synthetic hormones but there is the risk of FTP with that option.
Courtesy of Wikimedia Commons - creating the right conditions for birth
The diagnosis of Failure to Progress is made based on a vaginal exam which assesses the dilation of the cervix. Since we have already ascertained that FTP isnít a problem on its own, itís easy to understand this next recommendation - even though itís somewhat at odds with what weíve come to see as normal. If there are symptoms of a medical problem, consent to a vaginal exam. If everyone is healthy and happy, decline. A vaginal exam can not actually tell you when you will give birth, a healthcare provider can make guesses based on your dilation but thatís all they are. Guesses.
A vaginal exam has come to be the mainstay of labour and birth, itís viewed as unpleasant but harmless, but really it has risks. There are physical risks (infection, rupture of membranes and cord prolapse) and there are emotional risks. When a woman works hard through the night labouring to give birth and then discovers that her cervix is not as dilated as she hoped she becomes vulnerable to unnecessary interventions. However if a vaginal exam is used ONLY when there are other factors that suggest there could be a problem, then it can provide beneficial information. The bottom line must be health, not dilation, and health is not just physical, it is emotional too. If you donít know how dilated you are, you and baby are healthy, then you will just keep working until you give birth.
Courtesy of Wikimedia Commons - a healthy snack to nourish in labour
The duration of pregnancy and the length of labour are not problematic, it is the health of both mother and baby that must drive the decision making process. In order for a woman to make the right decisions she needs access to all the available information, her health situation and the scientific evidence for intervention. Can women rely on healthcare professionals giving them this information? Unfortunately not always, which is why women need to be as informed about the science of birth before they hire anyone.
True cases of FTP are very rare indeed. By knowing the science of birth, giving birth in a venue that understands unhindered birth, and hiring a provider who is using nothing but the most recent evidence based practices our odds of Failing to Progress are slim. Birth really does work very well under the right conditions when you effectively harness the science. If we pay more attention to health and less attention to clocks, if we reduce inductions to medical indications only, then we can reduce FTP caesareans very effectively and increase safety in birth for both mothers and babies.