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Failure to Progress

(Unsatisfactory Progress of Labor)

Definition

Failure to progress occurs when effective labor contractions do not lead to delivery of the baby. Failure to progress can be diagnosed in spite of medical interventions. The cervix may not dilate or efface. Effacement is a thinning of the cervix in preparation for delivery. Failure-to-progress can also happen if the baby does not move down the birth canal.
Fetal Descent Stations (Birth Presentation)
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The progress of the baby can be progressively measured.
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Causes

Some labors will stall without a clear cause. Uterine contractions can become ineffective, widely spaced, or both. This can happen despite the best efforts of a laboring woman and those who support her.

Risk Factors

Failure to progress may be more common in women over 35 years old. Other factors that increase your chance of failure to progress include:
  • Labor induction
  • Epidural pain relievers
  • Problems with amniotic fluid
  • Premature rupture of membranes
  • A large baby
  • History of failure to progress in a previous labor
  • Diabetes
  • Fertility treatments

Symptoms

The active phase of labor is defined by:
  • A cervix that has opened to 3-4 centimeters
  • Effacement
In this phase, the following would be signs that labor was not progressing as expected:
  • Less than three contractions in ten minutes, lasting less than 40 seconds each
  • Less than one centimeter change in cervical dilation per hour for two hours in a row despite frequent and strong contractions
Once the cervix is fully dilated, pushing will begin. If a woman has an epidural, it can take up to 3 hours to deliver the baby if this is her first delivery. If it is not her first delivery, the baby usually comes out within 2 hours if she has an epidural. Times are shorter for women who do not have anesthesia.

Diagnosis

Failure to progress will not be diagnosed until after the active phase of labor has been achieved.
A monitor may be inserted into your uterus. The monitor is a small catheter with a device to measure the intensity of contractions. This will get more a accurate record of the quality and strength of your contractions. The monitor can count how many there are, how long they last, how powerful they are, and how much time goes by between each one.

Treatment

Talk with your doctor about the best treatment plan for you. Options include:

Rupture of Membranes

Your water may be broken artificially using a tool made for that purpose.

Pain Medication

If you have not had any pain relieving drugs and you are in pain, your doctor may suggest that you consider pain treatment, such as an epidural. An epidural numbs the abdomen and legs.

Oxytocin

Oxytocin is a natural stimulant of the uterine muscle. It is used to improve the quality of contractions to help achieve adequate labor.

Delivery Options

If labor does not progress despite other efforts, or if the baby starts showing signs of distress, operative delivery will take place. In many cases this will mean having a cesarean delivery. Assisted vaginal delivery may be an option in situations where the baby is almost out of the birth canal during the pushing stage. A vacuum or forceps can be used to help the baby come out.

Prevention

There are no current guidelines to prevent failure to progress in labor.

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org/For%5FPatients

American Pregnancy Association http://www.americanpregnancy.org

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health Matters http://www.womenshealthmatters.ca

References

Labor dystocia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 24, 2013. Accessed June 26, 2013

Labor induction and cervical ripening. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated May 22, 2013. Accessed June 26, 2013.

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