Many women that are told they need a cesarean for “failure to progress” may not realize that the doctor is likely looking at their labor and dilation and comparing it to research called Friedman’s Curve. This research was completed with 500 women more than 60 years ago. A woman may be told that her doctor feels that she is not dilating quickly enough and she may feel pressure to follow the doctor’s recommendation for a cesarean; because, after all, the doctor is the one with the medical degree, right? The reality is, Friedman’s Curve no longer applies to the modern woman and yet, women are undergoing major surgery purely on the basis of this study.
In 2010, researchers studied records of 62,000 women from hospitals across the country and found that “mothers did not rapidly dilate starting at 3 cm like Dr. Friedman saw back in 1955.” (EvidenceBasedBirth.com) This new research shows that, for most modern women, 6 cm is when active labor begins. If active labor begins at 6 cm, then why are moms being taken to the operating room well before they have even reached active labor?
Further, it is common knowledge that there often comes a point in labor when everything seems to slow down. This is known as resting labor or slowed labor and it is a natural part of many births. As long as baby and mom are both weathering this change in pace, there is no reason to intervene. In most cases, this is a time for mom and baby to get a little rest before labor kicks back into full gear. What is needed in this case is patience and good humor. But, what many women get is a care provider that is overly anxious because the woman’s progress is not following Friedman’s Curve.
While it would be great if doctors and hospitals across the country would take notice of new information and change their policies and procedures, we know that these sorts of changes take time. Instead of waiting for change to take place, couples can take ownership of their birth. Couples can ask questions and come to their birth with a sense of curiosity and patience. If a medical “need” arises, there is usually plenty of time to ask questions and understand the medical need for a suggested procedure. If there is no serious emergent circumstance, there is often ample time to discuss options and evaluate a decision, without feeling pressure to act rashly.
I feel that it is a mistaken belief that a woman’s cervix needs to open on some sort of timeline or on a regulated pattern or time frame. Time and time again, women prove that when they step back and allow a birth to unfold in its own time, the outcomes are better than expected.
We would love to hear your comments and experiences with a diagnosis of “failure to progress.”
Jennika Cook, ICAN Blogger
Rebecca Dekker, Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned C-sections, EvidenceBasedBirth.com.