Humans have a habit of self-grouping. We find comfort in those who look and sound like us, and those who remind us of our upbringing. Society has a habit of generalizing the social aspects of groups; however, as individuals, we can also undoubtedly find several differences between ourselves and those who look like us. The medical field also has a habit of generalizing the biological functions of groups of people. Failure to progress, a known determinant of unplanned c-sections, is one of those unrealistic generalizations held by medical professionals across the United States that directly negatively affecting the black birthing community.
What is Failure to Progress?
Dystocia of Labor, also know as failure to progress, is a term used by medical professionals to describe what they perceive to be abnormally slow labor. Failure to Progress is held to a standard called “Friedman’s Curve,” which states that the “normal” length and pace of labor for first-time mothers is about 14 hours, with 8 hours for a 10-centimeter dilation. If the birth giver experiences less than three short contractions in 10 minutes, or less than a 1-centimeter change in cervical dilation per hour for two consecutive hours during active labor, she could be diagnosed with Failure to Progress after active labor is complete. If a birth giver shows signs of Failure to Progress, treatments administered by the doctor are usually left up to his or her discretion. Option include artificially breaking the water (rupture of the membranes), administration of pain medications such as an epidural, or administration of Oxytocin which is a natural stimulant described to strengthen the quality of contractions to speed up labor.
Why is this an issue?
Today’s black birth givers are more informed than they have ever been. Black mothers are researching labor, birth, and medication option and a significant amount are choosing vaginal births without pain medication. When care providers believe a woman is experiencing failure to progress, the birth giver’s chances of delivering without pain medication all but eliminate. What's worse? Her option to give birth vaginally is undermined by the significant chance that her labor will end in a c-section. In fact, failure to progress is the leading cause of unplanned cesareans.
Black women experience more cesareans than any other ethnic group, and although c-sections can be the safest options for some expecting families, the risk associated with unplanned c-sections cannot go unnoticed. Complications following c-sections can include trauma, failure to breastfeed, asthma/respiratory difficulties among infants, infertility, pain, infection, and even death. Unplanned c-sections can also bear a financial burden to families due to extended hospital stays, readmission to hospitals, and costs associated with many other unintended complications. Unsatisfactory birth experiences, pain, and financial difficulties following birth are linked directly to Post-Partum Depression, which is already extremely prominent (yet underreported) in the black community.
What can we do?
Journey Doula Services believes that an informed birth giver is a powerful birth giver. When a black woman includes a doula in her birth team, the chance of her labor ending in a c-section significantly decrease. Black mothers who hire doulas also experience shorter labors, fewer epidurals, and are more satisfied with their overall birth experience. Doulas are equipped with the emotional and informational support to help black mothers navigate through medical terminology as well as labor and coping techniques which are proven to lessen the chances of Failure to Progress. Doulas also take on the vital role of holding space for you and your wishes when you cannot do so yourself.
Also, it is essential to understand that no two birth experiences are alike. In doing so, we recognize that each birth giver is entitled to any wish they have regarding their birth as long as the safety of the infant and mother are assured. Creating a birth plan and discussing it with your care provider can help to solidify your wants as a birth giver while opening an honest line of communication with your OB or midwife. Expressing any worries, including issues or questions concerning failure to progress, with your care provider can help to alleviate your chances of being diagnosed. A simple conversation can enhance the possibility of having a satisfying birth experience.
The black birthing community experiences numerous amounts of hardship. Your birth experience should bring you not only comfort and joy but also reassurance in yourself and your support system. By actively working together to bring about informational and emotional support, we create a force that will hold our care providers to a higher standard. We will stand stronger than the hardships we confront, and by doing so, we will improve the birthing experience for those to come.