Does failure to progress really exist?

[Again]

I am 40 + 5 and don't feel like birth imminent. Head not engaged and no plug released. Don't feel pregnant most of the time because have no aches. Have been asked to bring in bag when go for check up tomorrow which I'm not going to do, but I do wonder whether I will actually go into labour at all. Are there some women for whom it judt doesn't happen. If I was left another 4 weeks would it happen? I'm not convinced it would anymore. Last time I didn't dilate even on synt drip and they did an ecs after 9 hours when baby was in distress (he had cord wrapped around neck).

[primadonnasmum]

Hello, I thought I might clarify a few bits of terminology for you. Failure to Progress is a term that is used when the cervix does not dilate fully during the first stage of labour, despite regular, frequent, strong "painful" contractions. Failure to advance occurs in the 2nd stage of labour when the cervix is fully dilated but despite lots of maternal effort the baby cannot be delivered vaginally by her own efforts. Failed Induction of labour occurs when despite all the different methods of induction being used labour does not become "established"..i.e the cervix does not dilate beyond 3-4 cms. However, the terminology "FTP" might also be used at this point.

[Margles]

Cleofartra: I assume you mean that the rates of CP didn't decrease between 1990 and 2000 despite the increased caesareans?

Your info re IVF certainly gives food for thought - the cousin's little boy was a product of IVF and was premature also.

[Cleofartra]

"That's largely caused by a lack of birth intervention isn't it?"


Did a quick google and came across one study which showed that the rates of cp didn't increase between 1990 and 2000. That's despite the fact that the c/s rate went up from 12% at the start of the decade to 20% by the end of it.

Also came across lots of reports on the link between IVF and higher rates of c/p (even when multiple birth and gestational length is controlled for). Interesting.

[Margles]

Poppet45 - re cerebral palsy: This seems a bit of a sweeping generalisation. I don't remember anyone with cerebral palsy from my childhood.

My husband's cousin has a son of three who appears to have it now.

According to wikipaedia (OK not the most reliable source) rates are slightly on the increase because of the survival of babies with low birth weights.

[everybodysgotone]

I had a EMCS for failure to progress, it's in my notes as "delay 2nd stage". DD was stuck high up in my pelvis and never descended into the 'birth canal' despite the fact I got to 10 cm and then waited for 3 hours for her to descend.
She was OP and brow presentation which means she was trying to come out with the widest part of her head (forehead) first which is why she got stuck.

[Dolittlest]

Anecdotal, but I went to 42+5 with my first baby before being induced ...and it didn't work. I wasn't even dilated 1cm and cervix not in the least bit favourable in any way. So c-section it was.

[Poppet45]

It's not just maternal and child mortality you want to look at but morbidity too. It's rare to see a child with cerebal palsy these days but I remember as a kid just about everyone had a friend or relative with a child with the condition. That's largely caused by a lack of birth intervention isn't it?

[togarama]

Isn't FTP just an umbrella term for all the specific medical and psychological issues which can slow or stop labour?

So, yes, it exists but it's not a medical diagnosis in itself, just a useful catch-all phrase which doesn't actually explain anything.

[Showaddywaddy]

Unfortunately, I also know several women who were very damaged by lack of intervention during their labours in the 50s for example. I also spend a lot of time with my aunt (brain damaged and requiring full time care) who was born after a 8 day labour where my grandmother begged for help and was told to shut up, go home and get on with it. She's alive though, so's her baby though with quite significant brain damage due to oxygen starvation. But grandma's 86 now and still can't talk about the birth without sobbing. And I'm as lentil-weavery as you like, would have given birth in a stream at midnight given half the chance but I thank god for medical intervention.

It's the sweeping generalisation of 'most women'. It makes people like me feel like I have to justify my decisions during labour. I had an 8hr second stage because I refused to accept intervention. I wholly believed my body could do it. All of the hcps I met were supportive of my decisions. DD was unbirthable. It was a ftp. I have 2 friends who were also true ftps. So most of my friends don't fit your sweeping statement.

"No, those women on here who actually had an induction or emergency c-section, were not lazy/stupid or anything (sorry to put it so blunt), only pulled along by people who should actually inform one properly and not, in your insecurity, force you into doing things you do not want". You're still saying we were pulled along or forced. You make it sound like I could have done more. Well I couldn't. Neither could you. DD was asynclitic and ot. It was not possible to deliver her vaginally.

I'm singling you out which is unfair and I don't mean to but my request was kindly meant. Be careful how you phrase things. You're just reasserted that our experiences weren't what we told you they were. That our birth experiences are unnecessary. Tackle the problem, tackle the medical mismanagement, question the stats, but don't make blind statements about what's already happened to real women. It really hurts.

[duchesse]

cleofartra- how many women do you know in their 50s, 60s and 70s who are still traumatised and/or damaged by their children's births even all these years later? I know loads. Natural does not necessarily equate to free from injury and is not necessarily always the best all round option even if the result is still a healthy baby. Faecal incontinence for example is very damaging and best avoided at all costs especially as one difficult birth may leave a woman suffering for upwards of 50 or 60 years.

[Cleofartra]

"All babies definately do not come out naturally in the end. This is why many mothers still die during childbirth in developing countries"


But don't you wonder how it was that in the 1960's in this country we managed to get the vast majority of mothers and babies through labour alive with only a 5% c/s rate?


Yes - maternal and infant mortality was higher than it is now, but it was still only a tiny fraction of maternal and infant mortality rates today in many developing countries.

[duchesse]

Kikibo, even 17 years ago, during my epic first labour (38 hours), they only got close to "threatening" labour (and the duty obstetrician was a complete arse) after 6 hours of second stage. In retrospect the fact that I was starving after three days of no food and he was a large posterior baby with a huge head that was taking its time moulding down into banana shaped, may have something to do with the slowness of the labour. My next two births were perfectly uncomplicated home births.

Until my last (4th) labour I felt like you that a vast number of interventions were largely unnecessary (and I still think that many obstetricians err on the side of extreme caution because they are cautious by nature). After seeing quite how quickly (1:45am, obs came in saying something not right, baby born 16 minutes later by c section and whisked off to nicu) things can go extremely wrong even in a multiparous woman with no previous problems like me, I'm not so sure. It's all about the level of risk the people involved (parents, midwives, doctors) are prepared to take.

Childbirth at best is wonderful, at its worst can be a lethal business.

[Poppet45]

I can assure you I wasn't coerced or pulled along into my c-section. I was adamant people like me didn't have them and I certainly wouldn't be needing one, but after getting to 7 cms on nowt but co-codamol and a wonderous birth pool, oh with some reflexology chucked in, and the next three on six - count them - six cannisters of gas and air, I just knew during the pushing stage there was no way DS was getting out. I knew he was stuck for at least an hour before the midwife noticed. I blame her for not having heard of a rest and be thankful stage, and for breaking the rest of my waters when I begged her not to. But I was too damn tired and had zero energy left - no one checked whether I'd be eating during the previous 19 hours either - to push him out. They came in with a general consent form for forceps or a section and I begged for a section. I never thought I'd do that, and even though the damn thing put me in a high dependency unit after a big bleed, I'm still glad I live in the century I do.
But yeah I don't like the general woolly term failure to progress either. We'd progressed bloody brilliantly all day... just got stuck at the end.

[Meglet]

I had FTP as my cervix is scarred together (which we only discovered when it wouldn't work). Managed a whole 1cm in 12 hours of strong labour and some very worrying dips / peaks in DS's heart rate. He was whipped out by cs when they realised my cervix was broken.

The consultant said afterwards it was lucky I hadn't been induced as it could have been a disaster.

[thecaptaincrocfamily]

All babies definately do not come out naturally in the end. This is why many mothers still die during childbirth in developing countries.
I would have been one of them, 10lb back to back baby which was resting on my full bladder that would not empty (very bruised after and passing blood during labour in urine). DD1 and 2 both ended as sections. DD2 was preventable as she turned to back to back during labour which I blame on midwife who forced me to have monitoring on lying on my back. Until that point I was active and all was progressing well. DD1 I was at home for 39hrs but still only made 9cm and only 3/5 engaged.

[kikibo]

Showaddywaddy,

Of course there are genuine cases, no-one ever claims that there are no cases like that. The poster here, two posts after mine (can't remember now how she is called, as I am lookng at your post on the former page ), was, I think in my uneducated but critical mind, one which possibly could have resulted in a bad result for either one of them or both if there had been no intervention. Only 2cm after more than 2 full days seems very little. Though it is the question if it was slow set on or not. Let's say it wasn't, who is to say that eventually she wouldn't have gone from 2 to 10 in an hour, but one cannot wait for ever.

However, 20% inductions seems to be a little bit much to me, which tells my sceptical mind that that induction/ftp is used for other purposes than mere help alone.
I cannot imagine that scaring a woman to death about the fact that she needs to progress, otherwise she will have to have a c-section, is very productive for her labour.

No, those women on here who actually had an induction or emergency c-section, were not lazy/stupid or anything (sorry to put it so blunt), only pulled along by people who should actually inform one properly and not, in your insecurity, force you into doing things you do not want (like the woman illustrated above). It is all bad enough for a pregnant woman to have to endure changes and not really knowing what is going to happen without having to be a doctor herself in order to judge properly. And not everyone, actually very few people, have the time to study the facts.

[frakkinup]

FTP is a huuuuuge term though. It covers:

labour not starting for various reasons
slow dilation for various reasons
closure of the cervical sphincter for various reasons
prolonged second stage for various reasons
etc.

So whilst there is evidence very few labours fail to start naturally, and evidence a slow dilation could be pathological or caused by emotional/psychological factors (which is usually the cause of a reversal in dilation) and evidence a prolonged second stage is typically physiological. Anyone want to say what definitively causes FTP?!? Or even what it is.....

FTP is far too often misinterpreted, both by expectant women and their caregivers. A long, slow first stage is not FTP. A long second stage where the foetus doesn't exhibit signs of distress is not FTP. Yet both of those are often labelled that way resulting in intervention.

I truly believe there are genuine cases of FTP but probably far fewer than widely accepted.

[Hulababy]

I was induced at 10 days overdue. After 50 hours I had got to 2cm dilated. I has a c section for failed to progress. It turned out that DD was in an odd position and was unlikely to have been able to be born naturally and the whole thing was somehow causing me to not dilate properly.

[carlyvita]

Cleofartra thanks for this article on the subject, found it really interesting.

[Showaddywaddy]

kikibo, while you speak some sense and obviously there are questions about and a discussion surrounding why a hospital intervenes and how it intervenes, you need to be very careful about how you word things. Because "in most cases FTP is just a way of passing people through who are clogging up beds" is a very sweeping and dismissive statement. And there is some little hidden gem in there that implies that those women who were unfortunate enough to have a ftp during labour, could have had it another way 'if only' they'd stayed at home/refused intervention/read up more.

I know this is not what you meant but 'most cases' refers to a lot of real women on here and their very real experiences.

[kikibo]

@Duchesse: I realise that there are some babies who genuinely do not get down there quickly enough and indeed those mothers would be totally lost if there wasn't anything else but natural, but in most cases FTP is just a way of passing people through who are clogging up beds, and inducing is a way of predicting when someone is going to give birth. More convenient than natural if you have only one midwife in attentdance (and that is fact). Why not offer a cesarian straight away? Then you do cut out the rest in the meantime, as most of those inductions end up with cesarian anyway.

That said, though, wrapping the cord round your neck, does not mean you will never induce natural labour at any point in time. That baby will probably get ready at some point to be born and mother will also get ready and then it starts. And then... it does not advance. But that is no dilation at all. I do not call a break in labour FTP. As people have stated here, it doesn't all go smoothly. But that is no reason to suppose that babies should be born after x amount of hours because that's the average baby's length, or even worse, it is a target.

[Poppet45]

Ditto 10cm, pushing for almost two hours, c section after 19 hours of labour for FTP. DS was OT and a whopper. I firmly believe I'd have never got him out on my own. Sigh.

[Showaddywaddy]

'all babies come out naturally when they're ready'. Definitely not true.

I was planning a homebirth and I did stay at home. I had an 8hr second stage (6hrs of active pushing before it became necessary to transfer). It wasn't until I had a cs that it became apparent what was wrong. DD couldn't come out as she was ot and asynclitic. If cs didn't exist, we'd both be dead.

So I made it to 10cm but still had a ftp as dd was unbirthable.

[duchesse]

kikibo- my baby was so tangled in her cord that she had basically used up all the available length. Her placenta was at the top of my womb, and she had wound the cord all the way around her body once and round her upper thighs five times, leaving her about 4 inches of spare cord. Nuchal cord entanglement hasn't anything on this, trust me. Nuchal cord is a doddle compared to attempting to kick start the labour of a baby who can't even touch the cervix with her head, let alone exit through it. Her entanglement was one of those rare situations where she would have died or been severely damaged had they not stepped in with the scalpels pretty sharpish. Mercifully she appears utterly unharmed now.

[mosschops30]

'all babies come out naturally when theyre ready' ...what a load of bollocks, no evidence for this as its simply not true.

I had FTP in my third labour, as in just wouldnt dilate, despite them trying for 4 days. Didnt get any further than 5cm.
Having been back through my notes its clear that ds2 would never have come out naturally, labour would never have started naturally either.

I have been induced with 2 out of 3 births. Im not sure the two inductions would have ever come out without intervention and ds2 certainly wouldnt