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.
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
Risk factors for failure to progress include:
- A large baby
- History of failure to progress in a previous labor
- A tired uterus that has experienced multiple pregnancies
Symptoms
The active phase of labor is defined by:
- A cervix that has opened to 3-4 centimeters
- An advanced thinning of the cervix known as 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
- No change in the baby’s descent into the birth canal after three hours of pushing if the cervix is fully dilated (10 cm)
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
Your doctor will talk with you about the best plan. Treatment 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. An example of pain treatment is 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.