Failure to progress, arrest of dilation, uterine inertia, and more cynically, Failure to wait. It’s all the same thing but different people say it differently. Titles aside, the result is all too often the same, an automatic caesarean. It is the top reason given for caesareans in many industrialised countries. But is a caesarean always the only solution for a labour which has stopped or slowed? And is a labour that stops really a problem best solved by major surgery?
Whichever term is used to describe it, it sounds like impressive medical lingo. It has to because it’s written on medical records (which are actually legal documents) to explain major surgery. It’s also written on invoices to families, insurance companies and governments. It has to sound convincing, because what family would accept “slow labour, no immediate complications” as a valid reason for a four or five figure bill, or an incapacitated woman with a new baby.
Far too many caesareans are best described as failure to wait during slow labour …. but that’s hardly convincing is it. Owing to the money paid for surgery, the odds are good that insurance companies and governments would rather pay a couple of hours overtime than the extra for surgery, equipment, extra staff, drugs, and extended hospital stays.
Honestly, if surgeons were to write “slow labour” on medical notes very few people would be inclined to believe the status of “Emergency Caesarean” which is by definition, any caesarean after labour has commenced. True emergency caesareans are referred to as “crash caesareans”, emergency caesareans are very rarely an actual emergency in the true sense of the word.
Everyone knows some women have lightening labours and others take longer, but to get from slow labour to emergency caesarean we need something convincing. Hmmmm. I know … ARRESTED DILATION!
The terms the medical establishment use to explain slow labour conjure up images of impending doom, imminent danger, or perhaps a defective women who couldn’t birth, let alone survive without drastic intervention. If we were to simply reframe them by altering the terminology to better suit what is actually happening, the caesarean rate might drop, because women wouldn’t be so keen to sign up for surgery if they were really in possession of all the facts. So how would we redefine things?
How about slow labour that is either accompanied by complications that require intervention, or slow labour where no one is in any danger.
This gives us a much clearer picture of what’s happening.
We have to remember that whilst caesareans can be life saving, they are not free from risks. They should be used sparingly because of the multitude of dangers they pose to women and babies, and future pregnancies as well.
According to Web MD the risks include:
Heavy blood loss.
A blood clot in the legs or lungs.
Nausea, vomiting, and severe headache after the delivery (related to anesthesia and the abdominal procedure).
Bowel problems, such as constipation or when the intestines stop moving waste material normally.
Injury to another organ (such as the bladder). This can occur during surgery.
Maternal death (very rare). About 2 in 100,000 cesareans result in maternal death.1
Caesarean risks for the infant include:
Injury during the delivery.
Need for special care in the neonatal intensive care unit (NICU).
Immature lungs and breathing problems, if the due date has been miscalculated or the infant is delivered before 39 weeks of gestation.
With failure to progress as the number one cause of caesareans it’s important to understand when slow, stalled, or no dilation truly poses a problem that requires medical intervention, and when simply playing the waiting game is best. If you research physiological birth and know when to consent to intervention and when to wait, if you are cautious about who you hire to attend your birth, your odds of avoiding either failure to wait or failure to progress are really good!
Failure To Progress VS Failure To Wait
Failure to progress isn’t always a failure to wait, a stalled or prolonged labour can either cause complications, or complications can arise as a result, but in and of itself, slow labour isn’t a problem. We need to be very clear about this, so that women understand. Slow labour is NOT a problem on its own. For surgery to be a prudent solution there need to be other medical factors, and of course those include emotional health (which is why dignity in birth is so crucial) as much as physical, and women need to know that simply waiting is an option when no physical danger exists.
Women need to have a very clear understanding of the potential risks of intervening, at this point in time far too many women are unaware that a caesarean for slow labour where no medical issues present, is unnecessary. This is reflected in the language women use to describe their births
“I had to have an emergency caesarean, I just wasn’t dilating fast enough”
“I just can’t give birth, my cervix doesn’t dilate”
Women genuinely believe this stuff because it isn’t being thoroughly explained to them in many instances. Often they are devastated to learn later that they underwent major surgery because someone didn’t feel like waiting for them to give birth. We have not come to be the most prolific species on earth because of modern obstetrics. So whilst it is true that many women and babies have died during a prolonged labour, it is also true that far too many women have been given caesareans when their labour is not problematic and their health is not in any danger, simply because of the length of time they are labouring.
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