Obstetric Lie #100- Failure To Progress
(Do you think I will be able to come up with 100 lies in obstetrics? I do.)
Failure to progress. Oft named as a reason for cesarean. Oft mentioned to the supine mom in the hospital as she is encouraged to get her epidural and "relax". By the naysayers in the natural birth community, it is often renamed, Failure to be Patient or just, Doc must leave to make his golf game.
Whatever it means to you, the term failure to progress is both powerful, disturbing, and strongly indicates not just lack of ability but complete and utter physical failure on the part of the mother. Personally, I would love to see this phrase just disappear from our culture all together.
And so, in an effort to trash this phrase for once and for all, lets take a closer look at it.
The Vaginal Exam
Ahh yes, you can not actually talk about the term "failure to progress" without first discussing the vaginal exam. Though the VE can give you plenty of useful information, it can not in fact tell you when you are going to actually HAVE YOUR BABY.
If you learn nothing today, learn this: Nobody will know how you are progressing, if nobody puts their hands in your vagina. If you don't want to be diagnosed as a failure, simply remove the test that does the diagnosing.
You do not need a vaginal exam to have a baby. I am serious. They will still come out.
So, one first step to eliminating the term, "failure to progress" is to eliminate the routine vaginal exam. The truth is, a woman can be dilated to a five for a month and have her baby at 40 weeks. A woman can also be dilated to a five and have her baby 10 minutes later. The body does not listen to textbooks. Especially textbooks that say you must dilate one centimeter an hour once you hit active labor. Like a baby, your body has no idea how it should act in order to ensure a textbook medical labor. Leave it alone.
Understanding Birth
The truth is this- science can not totally understand, quantify or write books about birth. You can take all measurable things and put them together and still not KNOW when a woman should have her baby.
Can we understand birth? On an instinctual and female level, yes. On a scientific level, no. Birth is not science. It involves head, emotions, body, place, fear, expectation, and much more.
Now lets assume you are getting vaginal exams and your body does "stick" or "fail" at a certain point of dilation.
What Happens During Birth?
As a birthing woman I believe there is much more going on here than simple measurements. A woman who is stuck at a six for hours on end is not a failure. Is the baby healthy? Is mother healthy? If the answer is yes to these questions then plenty could be happening that we can't see or feel.
You are taking a huge step into an unknown realm. I think this is part of the reason why the first labor is often the longest. It is not just the first time our body is doing this, it is the first time our brain and our spirit are doing this too. (Even if it not your first child, it is still the first time you are birthing THIS child.)
Maybe you fear something. Maybe you have to let go of something. Maybe you have to say goodbye to something. What could this "something" be? Closing a chapter and opening a new one on your relationship with your lover. Letting go of fears about becoming a mother. Letting go of fear and hurt and abuse and worry. Letting go of or working through past birth trauma. You are not failing, you are learning.
But birth is not just emotional either. It is also physical. Things can be happening in the body that we can't see either. Bones and ligaments are moving and stretching. The baby is being massaged as he comes down the birth canal. Your body is preparing colostrum for that first feeding. The baby is turning and finding his best way out. Your body should be moving with him and helping him. Being strapped down and getting medicated or cut open is not necessarily the answer. You are not failing, you are preparing.
Patience, Young Skywalker
If it takes time to become a Jedi, then I think it is safe to say that it takes time to become a mother. Why don't most babies just fly out? Your body births with all the accompanying signs and feelings and sensations in order to prepare you for motherhood. Motherhood is a big deal. It takes time to prepare for it. Let it take its time.
Stay where you feel comfortable laboring as long as you need too. If you get to your birth place and you are not very dilated and not showing signs of very active labor, go home. Don't feel like a failure about it. It is OK. You are excited to be on the journey.
Studies have shown that c-section rates are high in part to simple lack of patience. Talk to your care provider. Ask questions. "How long can I be in active labor before you start to worry?" "Can I avoid vaginal exams?" "If mom and baby are fine, can I labor as long as I would like?"
So how do you avoid failure to progress?
First, don't assume that the vaginal exam will tell you if you are progressing. If that is how we measure the pass/fail in childbirth, then I for one am scared to take that test. (It is always a bad sign when the person handing out the grades puts on a glove and asks you to spread your legs.)
Second, don't assume that staying in a certain spot dilation wise indicates failure. There is a lot we don't understand about birth. And there is a lot more to birth than what we can measure.
Then, be patient yourself. It isn't just up to your doctor to trust birth. It is up to YOU. Let your baby come when it is ready. An induced, undercooked baby may simply not want to come out yet. They can get it out. But not the way it normally comes. Let your labor start on its own, and then let it proceed on its own.
Stay mobile. Your body wants to move that baby down and out. Be logical. What positions assist that and what positions work against that?
Lastly, be aware of your own emotions and fears. What are they? What can you do about them? Could they effect your labor? Are you willing to face them and deal with them?
Oh wait- I forgot one! Don't get an epidural! Sometimes they cause no problem. But many a woman has had trouble with failure only AFTER the administration of drug that numbs half your body. Who would have thought?
Do some women have to have their babies via c-section? Of course. But your body is not a failure and it is not broken. It works. I am willing to bet that not only is your body perfectly capable of opening and having a baby, it is more capable of doing that than 100% of the male Ob's out there.
(Because of course, they don't even have vagina's.)
Comments
I never had any vaginal exams during my labor (or before it), but went from mild contractions 10 minutes apart to baby-in-arms in 5 hours, almost all of it in the safety of my home. I wish that more women could be confident enough with their bodies to stay at home and labor as long as possible so that they might avoid this bogus "diagnosis".
My point is, there isn't going to be much that you personally can do about the way things are trending in hospitals right now. What you CAN do is be choosy about your provider and make your wishes known in advance. Patients need to start taking more ownership over their care. If women stop going to doctors who urge them into C-Sections, those Dr's won't have any more patients.
The time of day has something to do with the c-sections but so does the length of time in the hospital. 3 of the last births I have seen, the c-section came up almost exactly 12 hours from check in. I tell all of my students to stay away as long as possible to stay off of that clock!
2nd time around, same thing, 38 weeks on the dot, was feeling laborish that morning as well but still wasn't "sure" (MW put EPO on cervix) finally picked up by the evening just like DS's birth, but with DD I had a CNM (who thought it was hilarious that I was so giddy and walking around at 7cm LOL! still though took me till 10pm to have her. So you think, ok w/ ds it took me 24 hours to fully dilate and about 40 min pushing, and that was with dilating for 3 weeks in advanced.
So that is why the whole failure to progress BAFFLES ME!!!!
It took me WEEKS to progress if you really want to think about it and even in active labor I only had to go HALF the distance and it STILL took me 24hrs the first time and I dunno 12 or 13 for the 2nd.
C-sections based on failure to progress should be called, C-sec due to impatient doctor who has better things to do than wait on a PATIENT. :/ Ironic, that we are called PATIENTS? who came up with that title considering doctors are the most IMPATIENT of people?!
With my son, I labored for 21 hours... the last SIX of which I was "stuck" at a 9.5
When my OB told me I needed a C-Section I felt like a failure. I felt like my birth was robbed from me. However, it was a good thing that I listened to my doctor. Once they got my son out, they found that he weighed 10lb 2oz and he only had an Apgar of a 3. Had I continued laboring I was told that either he would have died or they would have had to break my pelvis to get him out... without meds.
Just want to point out the other side of things. As a "natural birth" proponent it was hard for me to get rid of the guilt I went through. If Cesareans weren't so overdiagnosed it would have made it a little easier to accept the doctor's recommendations to me in the hospital. I feel for all the hopeful moms that go through similar experiences.
I was in active labour for 13 hours before I let them examine me. I was only 2cm. Another 3 hours and I allowed another and I'd only progressed 2cm. After 20 hours of active labour, I finally asked for pain relief. After almost 26 hours of labour, my baby was born via emergency caesarean and a general anaesthetic when she was showing signs of distress.
I had it so stuck in my mind that i wanted a natural drug free birth that I effectively wasn't present at the birth because there wasn't time to give me an epidural when they did intervene. For the record, my baby was born at 5am, not dinner time.
Yes, more people could have a natural birth and more belief in themselves but please be careful with your message and delivery because it's this steadfast belief that I could do it that ultimately lead to me missing my daughters first 2 hours of life. It took me months before I could think of what I missed and not cry.
This story needs more balance.
There are good OB's out there, but I agree too many of them rush in and upset normal birth.
I disagree. I think this story tells the truth of the matter- that far too many women are being to made to feel as though they are failures as birthing mothers, that childbirth has become yet one more item in the list of convenience activities that our society engages in, and that in far too many cases, women are being subjected to unnecessary major surgery. Because of this, those women who actually do need this surgery do not get the support they need at the time they need it most. Why not? Because it is routine. Mundane. Ho-hum. C-sections have gone from the realm of the extraordinary, resulting in additional care for the mother, to the realm of the ordinary, where no one really cares. It's not right.
As late as last September I used to believe that whether one had a C-section or not should be left up to each mother. I had not realized just how far out of whack society's views on childbirth had become until I was at church on October 10th last year. I was sitting in the women's meeting, after the service and Sunday School, and one of the women stood up to announce that she was going to be an auntie that day. Congratulations were offered all around. One women stated, "Oh, how wonderful! Your sister is in labour!" To which came the reply, "Oh, she's not in labour. She's having a C-section at 10:10 this morning so her baby can be born at the tenth minute of the tenth hour of the tenth day of the tenth month of the tenth year of the new millenium. It's supposed to be good luck."
I was dumbfounded. I had never heard of such a thing. And after much research and reading, my stand on current birthing practices has changed.
For those women out there who really do need to have c-sections, my heart goes out to you.
I had an amazing homebirth.
Day 2: fine,fine, still 1 minute contractions, made cupcakes, went to hospital, dialated 4cm. My daughter's heartrate was dropping. No drugs administered. 8 hours later, no further dilation, given Stadol which just made me hallucinate between the pain. Asked for epidural, the Hospital put it off. 15 hours later, still in excruciating pain, dilation still at 4cm. Epidural, passed out. 3 hours later, pitocin. Still no prOgress, my daughter was still trying to get out, my body remained at 4cm dilated. Fear for my daughter's life, as she was stressed, and we had an emergency Caesarian.
I was prepared for a happy, easy, natural childbirth. I had an easy pregnancy. Labour started at 41 weeks--no induction. I took yoga through 40 weeks. I wanted an epidural late during day 2, but the hospital kept putting it off. So yes, some of us do FAIL TO PROGRESS and it sucks. Then you get shame from all of the natural moms whose bodies were so much better than yours, la Leche league, and childless nutrition gurus who tell you that no doctors are ever needed for childbirth (omitting infant and maternal mortality). Thanks a lot for your support when things go wrong. I'm having my second in 2 months, would like a VBAC, but the natural maternal/child rearing groups are not supportive and pretend that I have done something wrong and that is why I had a Caesarian. Sorry, but no. I did nothing wrong. My doctor did nothing wrong. My husband was furious that we couldn't make my daughter's birth happy, but we are all glad she is alive and happy and wonderful--had I tried for a home birth, the likelihood is that she would have died & I would have had an even worse experience.
Where is the support for the women whose bodies didn't progress? Or that's considered so rare that we can be tossed to the side?
It's like nursing--not everyone can do it, and everyone I know tried and worked hard at it (except me--my daughter had no problem with it while my friends had plugged ducts, mastitis, poor supply--yes, that too is real when your child hasn't even gained 1 lb in 2 months but you insist on exclusively nursing--tongue tied, poor latch, lazy eating...and we are in a very pro-nursing community with free lactation consulting nearly every day of the week for new Mothers).
Don't literally throw out the baby with the bathwater simply because it doesn't fit in nicely with your agenda & dogma.
The point is I never felt a failure for having a csection ever! (i have had a VBAC since) I just wanted me and my baby to be born safe, i never cared how she came out!! I am a nurse who works in an intensive care unit and i have seen many things go wrong with childbirth! I also know many doctors who do not do csections to get home for tea! They work very hard and they try to leave most of it to the midwives and only intervene when needed. I agree their are probley some who dont, but dont put all doctors in the same box.
After being in the birthing room most of the day where I tried to have my dream birth-in a tub,I was offered so many other more natural things to help with the pain or progression. Finally,I did ask for an epidural,but after something like 90 hours of laboring did I ask for this and that was only because I hadn't the strength to go on any longer. I had to specifically ask for it by name.
In the US,I would have been cut open long before the 103 hour mark,that I know. I would have probably also had the epidural pushed onto me. I did end up having my water broken and finally induced,but that was all only to keep me from having to end up in surgery. By that point,they were truly worrying about me and my baby so they wanted to help me to deliver soon so I didn't end up on the operating table. I was greatly relieved and very grateful for the way things turned out.
So,this is one "failure to thrive" women who got to have the closest thing to her dream birth as was possible and I was only able to do this with the help of many patient midwives. There wasn't an impatient doctor in sight! Only loving women who helped me the best way possible.
rin him in the car!!!
I do believe C-sections are WAY over used and I did everything in my power to avoid it before falling ill in my labor. However, I am so glad the option of a section was available.
How can you possibly think that it is wise to give this advice....each birth is unique and must be evaluated by the mother and medical proffesionals present. No doubt there are c sections performed that are not necessary....some women even request them, but some are performed to save the life of the baby. Shame on you.