Labor dystocia – failure to progress

As women, we tend to blame ourselves for a lot of things that aren’t even in our control. I’ve heard many women do this if their labor doesn’t progress – move quickly enough – especially if they end up having to have a Cesarean section (C-section) as a result.

So, why do some women have this problem?

First, the idea of labor dystocia, or failure to progress, is determined on how quickly it’s expected for a woman to take to dilate and deliver the baby. This does vary depending on if you’ve already had a baby or not as second and subsequent deliveries are usually (not always) quicker than the first.

The failure to progress isn’t measured by the overall length of the labor, but how long it takes to dilate per hour *and* how long it takes for the baby to come forward, or descend and get well placed to be born. For example, the rule of thumb for a woman having a second child is she should dilate about 1.5 cm per hour, while first time moms are a bit slower at 1.2 cm per hour. The usual rate for the descent is about 2 cm per hour.

It’s not unheard of for a woman’s labor to be "perfect" for the first few hours and then for the labor to stop progressing and this can be extremely discouraging and frustrating for the woman.

Why a C-section then?

Labor is hard work not only for the mom, but also the baby. Every time you have a contraction, an incredible amount of force is being placed on the baby – this is why the fetal heart is monitored so closely. The medical personnel want to be sure that the baby is able to tolerate the birth process.

If your labor doesn’t progress, this can become too stressful on the baby and the heart rate may begin to drop, putting the baby in danger. At this point, the doctor’s main concern is to get the baby out as fast as possible, and that is with a C-section.

What causes labor dystocia?

For many women, it just happens, but there are a few risk factors too:

• obesity – obese women may have more difficulty progressing through labor
• baby not in the right presentation, positioned in the best way for birth
• anxiety – maternal anxiety can cause the body to slow down
• dehydration – one reason IVs are used is to be sure that mom stays hydrated
• inefficient contractions
• large baby
• pregnancy past 41 weeks
• epidurals – for some women, epidurals slow down progress, but for others, they may speed it up

What can be done?

In many cases, the obstetrician will recommend oxytocin, a medication that brings on or spurs on labor. This may work, but if not, often the only option for a safe delivery is to intervene with a C-section.

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Tags: pregnancy blog, labor and delivery, labor dystocia, failure to progress, c sections, cesarean sections, epidurals