Definition

Failure to progress is when apparently effective labor does not lead to delivery of the baby. This happens in spite of medical interventions. The cervix may not dilate and 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

Risk factors for failure to progress include:

  • A large baby
  • History of failure to progress in a previous labor
  • A "tired" uterus that has undertaken 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 per hour for two hours in a row
  • No change in the baby’s station 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.

Your doctor may insert a monitor into your uterus. The monitor is a small catheter with a device to measure the contractions. This will get more accurate information about the quality and strength of your contractions. The monitor can count how many there are, how long they last, and how much time goes by between each one.

Treatment

Your doctor will talk with you about the best plan.

Treatment options:

Rupture of Membranes

Your doctor may break your water artificially using a tool made for that purpose.

Pain Medication

If you have not had any pain relieving drugs, and 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 sometimes used to help achieve adequate labor.

Prevention

There is no known way to prevent failure to progress in labor. It can be detected early and managed by the following:

  • Confirm active labor before making a diagnosis
  • Perform amniotomy (inserted monitor) early in labor
  • Conduct frequent cervical checks
  • Augment labor with oxytocin to induce strong regular contractions