Failure to progress is an outdated term once used to describe slow labor during the first or second stage. Today, it remains one of the leading reasons for cesarean deliveries, especially among first-time mothers, accounting for nearly half of such cases.
The history of diagnosing failure to progress
The diagnosis was traditionally based on the “Friedman curve,” a graph introduced in 1955 to define the average length of labor. This curve analyzed the cervical dilation of 500 women. However, modern medical organizations like ACOG and SMFM revised labor definitions between 2012 and 2014, discarding the use of this outdated standard.
When is labor considered unusually long?
Determining the average length of labor is complex due to various influencing factors. First-time deliveries, epidural use, labor induction, or excess weight can all prolong labor. According to updated guidelines, labor is diagnosed as arrest of labour when the cervix is at least 6 cm dilated but fails to progress after 4-6 hours of strong contractions or oxytocin.
When does the pushing phase become too long?
The second stage of labor, also known as the pushing phase, is considered prolonged if there is no progress in the baby’s descent or rotation. The current guidelines are:
- ≥ 4 hours for first-time mothers with an epidural.
- ≥ 3 hours for first-time mothers without an epidural.
- ≥ 3 hours for experienced mothers with an epidural.
- ≥ 2 hours for experienced mothers without an epidural.
Conclusion
As long as the mother and baby are healthy, the length of labor alone should not trigger interventions unless it meets the criteria for “labor arrest.” Modern approaches focus on empowering mothers to labor at their own pace.
Reference: https://evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/
