The diagnosis of FTP ("failure to progress") in labor is a hotly contested term. What does progress mean? By whose definition? Should labor always be expected to progress? What if it stops and starts, or even goes "backwards" at points (as measured by cervical dilation)? If a woman's labor falls outside statistical norms, is that an automatic indication to intervene?
One of the dangers of making clinical judgments based solely or primarily on how long a certain stage of labor is taking is that time can often be irrelevant, and taking action based on arbitrary time limits might lead to undesirable consequences. For example, just yesterday a story came out about a baby who died of a brain hemorrhage after a vacuum extraction (a rare but known risk of this procedure). The reason for the vaccuum delivery? According to the doctor, the woman's baby was not crowning after over an hour of pushing. The doctor remarked:
Mrs Kaymak had been pushing for over an hour but had still not crowned. She seemed motivated and able to complete a successful vaginal delivery so it was decided to take her to theatre to perform an assisted vaginal delivery with the option of an emergency caesarean if necessary.Of course, we do not have the complete details of the situation, as is often the case with reports about infant deaths. However, the doctor never mentioned the baby being in danger. The woman's time limit had simply expired. And it was a short one at that--just over an hour! This was the mother's first baby, so that time limit seems especially out of place. It is not at all uncommon for a first-time mom to take 2+ hours to push her baby out.
The most dramatic real-life story of taking the whole picture into consideration, rather than making decisions based on arbitrary time limits, happened to my doula trainer during her fifth birth. She had given birth to four babies without pain medications, so she was surprised when her fifth birth proved especially challenging. She pushed and pushed and pushed with no sign of the baby coming out. After three hours of pushing, she finally asked for an epidural--the first time ever. She pushed for eight more hours with the encouragement of her obstetrician. She and the baby were both doing fine and showing no signs of distress; it was just an agonizingly slow process. Finally, the baby was born after eleven hours of pushing. They finally discovered the reason for the slow pushing stage: the baby had a compound presentation, which is when one or both of the baby's arms are up along its head. She remarked that she had an extraordinary physician; most doctors would have taken her in for a cesarean after only a few hours of pushing.
Please share your stories of FTPs (or SBPs= successfully being patient)!