“Failure to Progress” is one of the four main reasons for performing a cesarean section. Evidence shows that physicians vary widely in their assessment that labor has “failed.” Consequently, whether a cesarean is necessary or not varies among physicians. Physicians sometimes recommend a cesarean too soon when labor has not “failed” and perform a surgery that could have been avoided. Some caregivers are still using outdated practice guidelines to determine when labor is no longer progressing. Failure to progress is sometimes called “failure to wait.”

There may be wide variation among caregivers’ attitudes, beliefs, and values about birth and cesarean section in a group practice or hospital. These will play an important role in the information they provide—or fail to provide—and the decisions they make during your labor and birth. These attitudes, values, and beliefs affect birth outcomes.

Three Criteria for a Cesarean for “Failure to Progress” in the First Stage of Labor

A mother is considered to be in early (latent) labor until her cervix is at 6 cm dilation, not 4 cm as prior guidelines stated. Current obstetric guidelines state that all three of these situations should be present before a cesarean is recommended due to “failure to progress” in the first stage of labor.

Before you agree to a cesarean for “failure to progress” ask yourself these questions:

• Have my membranes (bag of water) ruptured?
• Has my cervix dilated to 6 cm or more?
• Have I had at least four hours of strong contractions without cervical change, or at least six hours with oxytocin without cervical change?

Criteria for a Cesarean for “Failure to Progress” in the Second Stage of Labor

If you have never labored before current obstetric guidelines recommend one of two situations should be present before a cesarean is recommended for “failure to progress” in the second stage of labor (pushing phase).

Before you agree to a cesarean for “failure to progress” in the second stage of labor ask yourself these questions:

• Have I been pushing without an epidural for at least three hours and the baby has not moved down or rotated?
• Have I been pushing four hours with an epidural and the baby has not moved down or rotated?

What You Can Do To Help Your Labor Progress

• Learn about the signs of labor and, if the bag of waters has not broken, stay home during the early stage of labor.
• Learn about different ways to cope with the early pains of labor and stay mobile and comfortable until you are ready to go to the hospital (if that is where you plan to give birth).
• Make a self-care plan with your caregiver to keep in touch during early labor and reassess your progress as you labor at home.

Your Odds of Having a Vaginal Birth Are Better if You Have Continuous Support from a Doula

Continuous support during labor increases the odds for a vaginal birth and may shorten labor. With continuous support during labor, mothers are less likely to use pain medication, have an epidural, need an instrumental assisted birth, or have a cesarean.
Babies may be healthier at birth. Families are often more satisfied with their birth.

How You Are Cared for During Pregnancy, Labor, and Birth Makes a Difference

A caregiver who is fully supportive of normal vaginal birth is more likely to respect your choices and include you in making all decisions regarding your health and the health of your baby. Your caregiver is less likely to use routine interventions and recommend inducing your labor for non-medical reasons. You should feel comfortable and knowledgeable discussing the benefits and risks medical procedures, induction of labor, and various methods of pain relief during prenatal visits and staying positive as your pregnancy moves forward.

You are more likely to have a vaginal birth if your maternity care team is focused on making sure you have all the support you need to have a normal physiologic birth. It is known that, for healthy pregnant people, supporting the normal physiologic process of birth while minimizing interventions leads to safer, healthier births.

Your odds are better if your caregivers are also knowledgeable and supportive of non-pharmaceutical, complementary methods of pain relief such as water immersion, aromatherapy, hypnosis, massage, sterile water injection, or TENS (transcutaneous electrical nerve stimulation).

Freedom of Movement During Labor and Birth is Important

You should have complete freedom of movement. Knowing how to move your body and change positions during labor can reduce pain and help labor progress. Being upright allows the pelvic diameter to widen and the tailbone to be flexible to accommodate the baby’s body. Being in an upright position also makes contractions more effective, and helps the baby rotate into a favorable position for birth.

You should have freedom of movement even if your labor is being monitored electronically.

Being upright rather than on your back reduces the length of the pushing phase and takes the weight of the uterus off the blood vessel that brings oxygen and nutrients to your baby. Your baby is also less likely to experience fetal heart rate problems. As your labor progresses you can kneel forward with support, lay on your side, sit on a birth ball, lean against the back of the bed and squat for birth.

Questions to Ask If a Cesarean is Recommended for “Failure to Progress”

If a cesarean is recommended for slow labor, you can ask:

• Is this an emergency, or do we have time to talk about it?
• What might be the benefits if we go forward with your recommendation?
• What would the risks be?
• What other options can we try first?
• What is likely to happen if we wait an hour or two?
• What is likely to happen if we don’t do the procedure?

If you plan ahead and discuss your concerns with your birth team (physician, midwife, nurse, doula, birth partner) you have an excellent chance of having a normal vaginal birth and avoiding a cesarean.

References

American College of Obstetricians and Gynecologists. (2019). Committee opinion No. 766: Approaches to limit intervention during labor and birth. Obstetrics and Gynecology, 133(2), e164–e173. doi: 10.1097/AOG.0000000000003074

American College of Obstetricians and Gynecologists, et al. (2014). Safe prevention of the primary cesarean delivery. American Journal of Obstetrics & Gynecology, 210(3), 179–193. doi: 10.1016/j.ajog.2014.01.02

Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7(7). doi: 10.1002/14651858.
CD003766.pub6

Resources

Talk To Your Doctor About Cesarean Section (video)

Lowering Your Chance of Cesarean Birth