Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned C-sections


“Failure to progress” is the number one reason for unplanned C-sections in the U.S. 

In 2013, researchers published a report of 38,484 first-time C-sections that occurred among a national sample of women. The overall C-section rate among first-time mothers was 30.8%. More than 1 in 3 (35%) of these Cesareans were due to a diagnosis of “failure to progress,” or slow progress in labor. This means that 10%, or 1 in 10, of all first-time mothers in the U.S. had a Cesarean for failure to progress during the years 2002-2008 (Boyle, Reddy et al. 2013).

To stop the flood of over-diagnoses of “failure to progress,” the following recommendations were made:

  • Inductions should only be labeled “failed” after at least 24 hours of Pitocin (plus water broken, if possible)—this clock should not start until after cervical ripening is completed, if needed
  • Women should be given an adequate time for both labor and pushing—and an “adequate” time is much longer than what has traditionally been allowed in the past

To read more on this topic from Rebecca Dekker, PhD, RN, APRN  click here.