Birth is not just about the cervix
How far dilated is she? Man, do we have to get away from this question as the answer to how far along a woman should be in labour. In fact, we need to move past the whole notion that a linear labour progress is the normal standard for healthy labour progress.
The Friedman’s Curve from the 1950’s has a lot to answer for here. Even though it is not an evidence-based approach to birth anymore its influence will still affect women whose providers are using this method to determine the best way to manage a woman’s labour .
Modern researchers have come to definitive conclusion that the Friedman’s Curve should no longer be applied to labours in today’s world, as too many women were being inaccurately diagnosed with Failure to Progress. By using it, we are in fact applying abnormal standards to what may be actually normal, as this evidence-based article points out:
In those cases, Failure to Progress might be more aptly termed “Failure to Wait.”
Your cervix should not be measured to a standard because every woman is unique. Her baby, her body, her birth is unique. Each person may have different types of factors that can either lengthen or shorten their labour. Failure to Progress stands for FEAR – TENSION – PAIN, and if you are not relaxed and calm then you are not going to be progressing very well anyway.
A woman can go from being told they are only 3cm dilated to fully dilated and birthing their baby in less than hour. Conversely sometimes there is the phenomena where the cervix can slow down completely or reduce rather than progress. This can happen if a woman has felt disturbed or interrupted by change of midwife, obstetrician, bright lights and technology or just fearful thinking.
Perhaps what we really need to come back to with the issue of slow labour is looking at the factors that may have caused this in the first place. Unless there is a compelling medical need to actively manage a woman’s labour, a women should be given:
The permission to walk, move, eat, drink, vocalise and do what their instincts are asking them to do.
The right to move freely, free from practices that lessen her ability to move.
The support and respect for her birthing autonomy and expression.
Failure to Progress has become the leading cause of unplanned c-sections. Reasons for failure to progress is still an area not well researched with some evidence linking it to induction of labour and the higher rates of interventions that occur, whilst other evidence points to a woman’s general reaction to the ‘medicalisation’ of her birthing process:
“Where there is an emphasis on time limits, on ongoing monitoring, on the time constraints of the medical staff, such as shift changes and obstetrician’s rosters, and on bright lights and technology, women become stressed, hormone levels alter, and the birthing process slows down or stops, leading to an intervention domino effect and more caesarean sections.[208]”