Failure to Progress in Labor
Did you know that a significant portion of primary cesarean sections in the U.S. are diagnosed due to "failure to progress"? This label is often applied when labor doesn’t seem to follow the "ideal" timeline, but what does "failure to progress" really mean? For many women, it’s not a matter of their body failing—it’s a result of a rigid approach to pathologizing labor. This brings us to an important question: How is it that homebirths, with their more relaxed approach to monitoring labor, experience drastically lower rates of cesarean sections for the same reasons?
The idea of "failure to progress" often leads to unnecessary interventions like Pitocin or cesareans, but the truth is, labor is far more nuanced than a simple countdown of centimeters. Let’s break down what this really means and why you shouldn’t panic if labor doesn’t follow a textbook timeline.
What Does "Failure to Progress" Even Mean?
Doctors used to rely on a concept called Friedman’s Curve, which was developed in the 1950s. It suggested that labor should follow a basic timeline, and if it didn’t, intervention was needed. The problem is that this Friedman study was based on just 500 women - all white - and more than half of them had forceps used to speed up delivery! Not exactly a natural, unmedicated scenario, right?
For decades, doctors used this curve to decide if labor was taking "too long." If your cervix wasn’t dilating fast enough according to this outdated chart, you might be labeled with "failure to progress" and encouraged to have interventions like Pitocin or even a cesarean.
What We Know Now
Thankfully, we now have much better data. A 2010 study by Zhang and colleagues looked at over 62,000 births and found something important:
Active labor usually begins around 6 cm dilation, not 4 cm like had been believed previously.
Labor can have long pauses or slower moments, and that’s totally normal. Some women go hours without much cervical change, then suddenly progress quickly.
Just because labor is slow doesn’t mean it’s "stalled." As long as mom and baby are doing well, patience is often the best approach.
So if we now have better guidelines, shouldn’t cesarean rates be dropping? Yeah probably but they’re not 😅 One big reason is that many providers haven’t fully adopted the new guidelines yet. Another possibility is that while some cesareans might be prevented by using the new labor definitions, other factors—like more inductions or changing hospital policies—could be balancing out the numbers.
So, When Is Labor Actually "Too Long"?
According to the latest guidelines, labor arrest (the correct term instead of "failure to progress") should only be diagnosed if:
You’re at least 6 cm dilated with your water broken
You’ve had no cervical change for 4 hours (with strong contractions) or 6 hours if contractions aren’t as strong
And when it comes to pushing, a baby’s descent is considered too slow if:
First-time moms with an epidural push for more than 4 hours
First-time moms without an epidural push for more than 3 hours
Experienced moms with an epidural push for more than 3 hours
Experienced moms without an epidural push for more than 2 hours
What Really Impacts Labor Length?
Labor is unique for every mom, but a few things can naturally make it longer or shorter:
First-time moms tend to have longer labors—your body is doing this for the first time!
Epidurals can slow labor down by relaxing muscles (which sometimes makes pushing harder).
Medical induction often makes labor longer compared to natural labor starting on its own.
Baby’s position matters! If baby isn’t in an ideal position, labor may take longer.
Moving around and using upright positions can help labor progress by working with gravity and opening the pelvis.
The Bottom Line
If you hear the words "failure to progress," don’t assume that means something is wrong. Labor isn’t a one-size-fits-all process, and your body isn’t "failing" just because it doesn’t match a chart from the 1950s.
The best thing you can do? Trust the process, stay informed, and make sure your birth team understands the latest research on labor progress. Sometimes, patience is the best "intervention" of all 💛
Join the Autonomous Birth Workshop to learn how to navigate decisions in labor and confidently speak up for yourself.
