HWN Suggests

Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned Cesareans

The language of childbirth is filled with paternalistic terms that indicate the power differential between doctors and pregnant families, as well as the supposed inferiority of our bodies. The physician “delivers” the baby, birthing people are “not allowed” to eat or walk untethered during labor, our labors “fail to progress” or “stall,” our pelvises are “insufficient,” our pushing efforts are “inadequate,” we’re “too short” or “too fat”, or our babies are “too big” to birth vaginally.

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 Evolving understanding and treatment of labour dystocia

Dystocia remains the most common indication for emergency caesarean section in England and for primary caesarean section in the USA. As such it is a major contributor to operative and instrumental intervention, especially in nulliparous women. Yet it remains an enigma with a plethora of diagnostic terms attributed to it (‘prolonged labour’, ‘failure to progress’) and contrasting thresholds for initiating intervention in clinical practice. Dystocia is caused by a combination of factors that traditionally have been understood to either involve the expulsive forces (uterine contraction or powers), or presentation, position, and fetal development (passenger) or the maternal bony pelvis (passage) or a combination of these. This suggests two types of dystocia: a mechanical obstruction (mechanical dystocia) and one that is related to contractions (functional dystocia). The former is still common in low income countries.

Articles of Interest

After a devastating birth injury, hope

Obstructed labor can kill the mother, too, or crush her bladder, uterus and vagina between her pelvic bones and the baby's skull. The injured tissue dies, leaving a fistula: a hole that lets urine stream out constantly through the vagina. In some cases, the rectum is damaged and stool leaks out. Some women also have nerve damage in the legs.

Diagnosis and Management of Labor Dystocia According to the Friedman Curve

Labor dystocia or abnormal prolonged delivery is one of the common indications regarding unplanned cesarean deliveries. A better understanding of the diagnosis and management of labor dystocia according to friedman curve could lead to new opportunities to increase the rate of vaginal delivery.

Labor Dystocia, Prolapsed Umbilical Cord, Cesarean Section

Signs and symptoms of labor dystocia are that labor is not progressing: dilation is not progressing as expected, effacement is not progressing as expected, fetal descent is not progressing as expected, or fetal station isn't changing as expected.

Labour Dystocia

The nurses and myself tried everything to get the labour going but nothing happened. The doctor recommended for the dose of oxytocin to put to the max since baby was handling the contractions with no complications. Switch out happened and was assessed around 52 hour mark and the doctor on call that night told me it was best to have a C-section since baby wasn’t actually tolerating the contractions that well and I had blood in my urine from the catheter. I knew it was coming but I was trying to be hopeful. But obviously was devastated because I wanted a VBAC

Obstructed labor and shoulder dystocia

Dystocia of labor has become one of the leading indications for operative delivery during the past few years. Dystocia of the first stage of labor complicates 8-11% of all vertex delivery, and in the second stage of delivery it is at least as common. Dystocia may result in part from three factors: uterine activity, the fetus, and the pelvis.

Obstructed Labor Does Not End at Delivery...

Dr. Romanzi opened by describing the many sequalae—both short-term and long-term effects—related to P/OL including maternal death, stillbirth, fistula, sepsis, infertility, chronic pain and mental health issues, as well as cerebral palsy, neurological damage and paralysis among infants. Dr. Tripathi added that the World Health Organization (WHO) has called obstructed labor “the most disabling of all maternal conditions,” contributing to 2.8% of global maternal mortality and complicating approximately 3–6% of deliveries.

Obstructed Labor, Evolution, and Health Disparities

Medically, of the causes of maternal morbidity and mortality, pelvis size is often implicated in obstructed labor, which is a failure of labor to progress due to mechanical reasons.

Obstructed labour: Reducing maternal death and disability during pregnancy

Obstructed labour is an important cause of maternal deaths in communities in which undernutrition in childhood is common resulting in small pelves in women, and in which there is no easy access to functioning health facilities with the capability of carrying out operative deliveries.

Recalling A Complicated Birth

Shoulder dystocia is top of the list of harrowing complications of labor. The techniques used to manage this complication more often result in success than not, but facing it is no less terrifying.

Risk Factors of Dystocia in Nulliparous Women

Dystocia is defined as slow progression or lack of progression of labor which occurs in 25-30% of nulliparous women and is regarded as the cause for two thirds of cesarean sections in these women. If not diagnosed and treated, this condition can lead to maternal/fetal morbidity and even the mother’s mortality. Women who experience dystocia often undergo surgical interventions such as emergency cesareans, and vacuum and forceps deliveries which cause considerable physical problems for mothers.

Shoulder Dystocia: the real story

A lot of midwifery and obstetric learning resources focus on how to manage complications or problems, rather than on how to prevent them happening. Although in some cases shoulder dystocia is unavoidable, there are a number of ways to reduce the chance of it occuring:

The Pathophysiology of Labor Dystocia: Theme with Variations

For a common problem, we know surprisingly little about the molecular and physiologic causes of labor dystocia. Despite decades of clinical information, we lack data on the underlying biology and potential for mechanism-driven interventions. Some labor dystocia is due to poorly stimulated contractions which might be resolved with oxytocin augmentation, but this does not explain all dystocia diagnoses.

The Train Wrecked in Slow Motion

I gave birth at 45. It was a miracle that almost cost me everything. My husband brought the car around to the front of the house. Knowing that my baby’s first cry would reverberate through the world before noon was strange and scrumptious. I was four months shy of 46; this child would be my third and last. It was late to be having a baby—I knew I was tempting fate. Women of advanced maternal age often have complications.