There are many different reasons why women have C-sections, and there can even be multiple reasons from each birth.
Some reasons include having a large baby, baby’s position, fetal distress, infection, failure to progress, multiples, and more.
Today we are going to talk about one of the most common reasons we hear from our followers, which are similar to the reasons in our own operative reports.
What is Failure to Progress?
Failure to progress is typically “diagnosed” by a provider when a mother’s cervix does not make significant change after so many hours.
Historically, evidence has shown that many care providers do not give women the chance to progress in the first stage of labor (dilating from 0-10cm) or enough time to push the baby out when they reach complete.
In 2011, ACOG and SMFM (the Society for Maternal-Fetal Medicine) put out an updated definition on time limits for the first (dilation) and second (pushing) stages of labor.
The guideline says that a woman is not considered to be in active labor until six centimeters and cannot be termed as “failure to progress” until she is at least six centimeters dilated, her waters have ruptured, and no cervical change has been made in six hours of labor.
ACOG released an updated report in 2024 which reiterates the same guidelines above but also includes that these are “conditional recommendations” with “low quality evidence,” meaning “the balance of benefits and risks will vary depending on patient characteristics and their values and preferences. Individualized, shared decision making is recommended to help patients decide on the best course of action for them” (ACOG 2024).
Something that is essential to understand is that if there is ANY progress at all, that equals change. And, remember, labor progress is not just about cervical dilation.
Labor progresses through these six stages:
- The cervix moves from posterior to an anterior position
- The cervix ripens and softens
- The cervix effaces
- The cervix dilates
- The baby’s head rotates, flexes, and molds
- The baby descends, rotates further, and is born
What Causes Failure to Progress?
Often when labor stalls, there can be various reasons why, and knowing these reasons can help labor continue to progress on its normal path.
Induction
Induction may be chosen for a medical reason or simply because the mother decides she is ready to meet her baby. While there are several different types of induction, it’s important to understand that because the body isn’t always ready to begin labor, it can be a long process. It may take several hours or even days for labor to begin.
This doesn’t mean your body is failing to progress.
Water breaking prematurely
Although somewhat rare, your bag of waters may break or rupture slightly before labor begins (or in very early labor). When this happens, hormones are released that typically help labor progress. However, if the membranes rupture first, it can take a long time for the body to register that it’s time to begin labor.
Additionally, when this happens in early labor (when baby is still higher in the pelvis) baby may drop down in a wonky position.
Once waters are broken, providers typically start a “time clock,” in which they begin monitoring for signs of infection within 24 hours. If “nothing is happening,” they may jump to recommending a Cesarean.
Remember, it may take time for your body to catch up or realign baby after a premature rupture of membranes.
This does not mean your body is failing to progress.
Poor fetal position
Fetal positioning can have a big impact on the way a cervix changes. If a baby’s head is not applied to the cervix correctly, it can cause slow dilation. There are positions changes and movements that can help baby rotate, but it may take time.
This does not mean your body is failing to progress.
Failure to wait
Sometimes labor just takes time. It can be protracted by factors like scar tissue on the cervix, malpositioned baby, mother’s exhaustion or a mental hurdle. Understanding that a woman’s body is not a time clock and doesn’t have to follow exactly when a text book says is vital.
Being patient and letting labor begin on its own is ideal, and once labor begins, allowing and trusting the body to take its own course is best.
Ways to Help Avoid Failure to Progress
Before we leave you today, we want to drop some quick tips for avoiding a Cesarean due to “failure to progress:”
- Wait it out and trust the process
- Hire a doula who is trained in understanding fetal positioning and helping baby rotate
- Keep moving while you are in labor
- Have a good provider who will be patient with the labor/birth process
- Address signs of hunger, exhaustion or fear / anxiety
- Use the bathroom frequently (a full bladder can hinder baby’s descent)
- Avoid induction unless truly medically necessary
- Avoid rupturing membranes early on in labor, ESPECIALLY if you’re having signs of a poorly positioned baby
Listen to these episodes of The VBAC Link Podcast to hear real from moms who navigated “failure to progress” on their VBAC journeys:
- Episode 56 – Rachel’s VBAC + Failure to Progress
- Episode 325 – Failure to Progress: What It Isn’t and What It Is…
- Episode 371 – Aisha’s Special Scar VBA2C After “Failure to Progress” + Uterine Dihiscence
- Episode 395 – Shannon’s Induced VBAC With Preeclampsia & Ehlers-Danlos Syndrome + Big Baby + Failure to Progress
- Episode 397 – Dr. Jen’s VBAC After Failure to Progress + Pelvic Floor Breathing & Pushing
- Episode 417 – Hannah’s Two VBACs + Failure to Progress + Labor & Shoulder Dystocia + Close Duration
Nervous about your upcoming VBAC? Want to feel informed and confident? Register today for our Ultimate VBAC Course for Parents, and learn everything you need to know before your big day!
