Critique the term failure to progress “labour dystocia.
The term labour dystocia comes from Greek word dys which means abnormal, painful, disordered, and difficult. Tokos is the second part of the word meaning birth. The term labour dystocia therefore indicates a condition of stopped or slowed labour (Downe & McCourt, 2008). The failure for women to progress to full labour and deliver normally is a common indication for caesarean section accounting for approximately 30% of all caesarean sections (Bluff & Holloway, 2008). Women tend to blame themselves for a lot of things that are not within their control. According to Neal et al, (2010) the terming of a medical condition such as dystocia using the word “Failure” gives the woman concerned a negative connotation that makes them feel responsible for the condition.
The diagnosis of a woman with “Failure to Progress” is deemed by reproductive experts as “failure to be patient” since there is no absolute justification for speeding up a birth that is taking its time. Some birthing experts contend that at times the baby might not even be in distress and therefore there is no need to put the mother through a process that might affect her psychologically in future.
The use of negative terms for the condition has negative impact on women as they place the blame on the woman who already has a life threatening condition to deal with. Some women also feel that it is wrong to place the “failure” on the uterus, the cervix or even the baby (Stewart, 2001).
The term also prompts doctors to recommends caesarean section even if they may be objected it. Some women feel that the mention of the term brings to the fore emergency response which may not be warranted (Zhang, Troendle &Yancey, 2002). They feel that the baby may not even be distressed and so the CS may not be necessary. Moreover, women who experienced the condition suffer psychological harm as they are likely to fear child birth.
Theoretically, women in labour are supposed to follow the Friedman’s curve which indicates the average time and progress of labour (NICE, 2007). But not all women follow the curve because biological processes are diverse. The curve is supposed to take care of both long, drawn labours and short; precipitous labours as well as those which are in extreme cases.
Factors that increase the likelihood of a women being labelled a failure to progress
Poor assessment of established labour,
Poor assessment of established labour is a factor that increases the likelihood of a woman being labelled a “Failure to Progress”. Currently, birthing experts use the Friedman curve to assess the progress of a woman in labour (Fraser, & Cooper, 2008). The curve is plotted using the rate of cervical dilation against mean time limit. The Friedman’s curve is however subjective and for women who cross the action line they are likely to follow the routine. The partogram currently being used contains alert and action lines and indicate latent and active phases of labour. Some birthing experts have faulted this criterion of assessing labour as it was initially meant for clinical management purposes. The Cochrane review recommended that the partogram should not be part of standard labour procedure, (Lavender, Hart and Smyth, 2008). Correct assessment of labour varies between individual practitioners, local policies, birthing units, hospitals and regions. The methods used to assess labour in women are invasive and have unproven and unevaluated benefits. Some women are therefore subject to poor assessment and could be wrongly diagnosed with “Failure to Progress”. Lavender, Hart and Smyth, (2008) contend that while some could actually be facing the condition, the genesis of the condition could actually be a fault from a medical practitioner.
Fear/stress response of women
The fear of delivering puts many women under psychological stress which has an ultimate effect on labour. When stress hormones such as adrenaline meet with beta-receptors from the uterine walls, they exhibit contraction and slow down labour. When women feel threatened or insecure, her labour progression pauses as she for instance reaches a place of perceived safety. Stress responses can be triggered by external factors like negative stimuli such as bright lights, entry into the labour ward, lack of provocacy and unfamiliar noises, (Zhang, Troendle &Yancey, 2002). Lack of support from caregivers can also stimulate stress response. In addition stress response can be a consequence of deep-rooted anxieties such as traumatic past deliveries or the fear of pain. It is therefore possible that a woman experiences “Failure to Progress” due to one or more of these factors.
Use of epidural in labour
Epidural analgesia is a medical technique to provide pain relief during labour and has a strong association with dystocia. An assessment of the risk factors associated with dystocia showed that 71.2% of women treated with epidural analgesia experienced dystocia. A previous survey of 106,755 deliveries also linked dystocia to epidural analgesia (Stewart, 2001). Epidural analgesia induces fear in women which triggers stress response and prolongs labour. The technique also lowers the levels of oxytocins which causes prolonged durations of labour.
The decrease in oxytocins levels relaxes the normally firm pelvic floor muscles reducing the contractions and therefore increasing chances of malrotation, malposition and delayed labour. Prior to agreeing to epidural analgesia, women should be offered the option of epidural anaesthesia which effectively reduces pain and is associated with less adverse effects on delivery.
References
Bluff, R. & Holloway, I. (2008). The efficacy of midwifery role models, Midwifery, vol. 24, pp.
301-9.
Downe, S. & McCourt, C. (2008), From being to becoming: reconstructing childbirth knowledge, in S Downe (ed), Normal Childbirth: evidence and debate, 2nd ed, Churchill Livingston, London
Fraser, D. & Cooper, M. ( 2008), Survival Guide to Midwifery, Churchill Livingstone, London
Lavender, T., Hart, A. & Smyth, R. (2008), Effect of partogram use: outcomes for women in spontaneous labour at term (review), Cochrane Database of Systematic Reviews, Issue 4, Art No. CD005461. DOI: 10.1002/14651858.CD005461.pub2
Neal, L., Lowe, N., Ahijevych, K., Patrick, T., Cabbage, L., & Corwin, E., (2010) Active labour duration and dilation rates amongst low-risk nulliparous women with spontaneous labour onset: a systematic review, Journal of Midwifery and Womens Health, vol. 55, no. 4, pp. 308-318.
NICE (2007), Intrapartum Care: care of healthy women and their babies during childbirth.
National Institute of Clinical Excellence, London.
Stewart, M. (2001), Whose evidence counts? An exploration of health professionals perceptions of evidence-based practice, focusing on the maternity services, Midwifery, vol. 17, pp. 279-88.
Zhang, J., Troendle, J., &Yancey, MK (2002),Reassessing the labour curve in nulliparous women, American Journal of Obstetrics and Gynecology, vol. 187, no. 4, pp. 824-8.
