08/22/2026
Have you been labeled in birth with failure to progress? Yes? Read on until the end!
I just got done listening to Evidence Based Birth Podcast episode 224, and it was all about âfailure to progress.â Link here is you want to listen- https://evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/
Failure to progress is the number one reason for a C-section in the U.S. About 1 in 3 women will be labeled as having failure to progress during labor and end up going back for a C-section.
But what really caught my attention was learning more about Friedmanâs Curve. So if you donât know, this is like a studied run in 1955 that measures how quickly the average cervix should go from 0 cm to 10. Today this study is still used a lot to give providers an idea about how quickly labor is âsupposedâ to progress came from.
Whatâs the problem with that?
Friedmanâs research was done in 1955 on only about 500 births.
And do you know what else was happening during this study in 1955?
TWILIGHT SLEEP!!!
If youâve never heard of twilight sleep, women were given drugs that could heavily sedate them, sometimes even to the point of sleeping. This cause them to forget the experience. But!!!! No it didnât block the sensations of contractions.
Think about how different that is from birth today.
Oxytocin is what helps contractions become stronger and more effective. When youâre experiencing labor, your body is responding to those sensations and releasing hormones for more contractions. With an epidural today, you may feel very little or nothing at all. That is why labor can sometimes slow down after an epidural. With twilight sleep, women could still experience the physical sensations while also being extremely sedated and relaxed. Equally quicker labors vs. todayâs epidural births.
Also the population was different. Women giving birth in 1955 were generally younger, and the population was smaller-bodied than todayâs population.
Then, around 2010, researchers started taking another look at how labor actually progresses because they wanted to lower the C-section rate.
They found that active labor actually begins closer to 6 cm, while Friedmanâs research considered active labor to begin around 4 cm.
That is a HUGE difference when youâre deciding that somebodyâs labor has âstalled.â
The newer guidelines recognize that labor before 6 cm can take longer and that this can still be NORMAL. They also allow more flexibility for things like inductions and epidurals.
And this is where I really started thinkingâŠ
If around 1 in 3 women are being labeled with abnormal labor progression, maybe the problem isnât that 1 in 3 womenâs bodies donât know how to dilate. The problem is using the 1955 freemanâs curve.
They even found that providers were more likely to follow the newer guidelines when the birth happened on a weekday rather than a weekend. And allowing longer labors according to the newer guidelines did not show additional safety problems in the research.
There was also a 2016 study in Italy with around 400 people divided into two groups. One group followed the older Friedman-style labor management, while the other followed the newer 2017 guidelines.
The Friedman group had more restrictions, including lying down and not eating, while the newer-guideline group could move around, eat, and drink.
The result?
The women in Friedman curve group were 2x as likely to have a C-section and experienced more interventions. The group following the newer guidelines had fewer interventions and a 10% C-section rate.
Then there was research looking specifically at medical inductions and failure to progress. Among those who ended up having a C-section for failure to progress 80% âŠ80%! did not meet the newer 2017 guidelines before the C-section was performed.
That was incredibly eye-opening to me.
We hear âfailure to progressâ and automatically think the womanâs body failed to do something it was supposed to do.
But how often was her body actually given enough time?
And the part that AMAZES me the most is realizing that so much of the thinking about how quickly labor âshouldâ progress traces back to research from 1955 not only on just around 500 births, but births happening during the era of TWILIGHT SLEEP.
Yet weâre still having conversations today about womenâs bodies âfailingâ to progress.
Maybe sometimes it isnât a failure to progress.
Maybe itâs a failure to wait.
