Failure to Progress (FTP) is a term used when labor slows down or stalls and does not result in the expected cervical change or the baby’s descent through the birth canal. FTP is one of the leading reasons for medical intervention, including Cesarean sections. Understanding the factors that influence the pace of labor allows birthing individuals and their support teams to proactively implement non-medical strategies that can mitigate the risk of a stall. Focusing on physical readiness, movement, and the emotional environment supports the body’s natural physiological process and encourages a smoother progression.
Understanding the Causes of Slowed Labor
The reasons labor might slow or stop are often categorized into three inter-related factors, commonly known as the three Ps: Power, Passenger, and Passage. The Power refers to the strength and effectiveness of the uterine contractions, which must be strong enough to efface and dilate the cervix. When contractions are too weak or infrequent, the dilation process can protract or arrest entirely, leading to a diagnosis of FTP.
The Passenger relates to the baby, specifically their size, position, and presentation within the pelvis. A non-optimal position, such as occiput posterior (OP)—where the baby is facing the mother’s abdomen—is a frequent cause of slowed progress. This positioning makes it difficult for the fetal head to navigate the maternal pelvis effectively, often requiring a longer rotational process.
The final factor, Passage, involves the bony pelvis and the soft tissues of the birth canal. The shape and size of the pelvis must be adequate to allow the baby’s head to pass through. Issues with the Passage are less common than difficulties with Power or Passenger, but a full bladder or rectum can also mechanically obstruct the baby’s descent through the soft tissues.
Preparing the Body Before Labor Begins
Preparation for labor begins well before contractions start, focusing on physical fitness and pelvic alignment throughout the pregnancy. Engaging in regular, moderate-intensity aerobic exercise, such as daily walking, supports the stamina required for labor. The American College of Obstetricians and Gynecologists (ACOG) encourages such activity for uncomplicated pregnancies, as it helps build endurance.
Specific daily practices can also promote an optimal fetal position, which is head-down and facing the mother’s spine. Exercises like pelvic tilts, Kegels, and the butterfly stretch help strengthen and relax the pelvic floor and surrounding muscles, creating space for the baby. Spending time in positions where the knees are lower than the hips, such as sitting on a birth ball or leaning forward while seated, encourages the baby to settle into the ideal anterior position.
Maintaining proper hydration and nutrition throughout the third trimester ensures the uterine muscle has the energy reserves needed for powerful, sustained contractions.
Optimizing Positioning and Movement During Labor
Once labor begins, active management of positioning is a highly effective tool to promote progress and correct non-optimal fetal alignment. Upright positions, including standing, walking, and slow dancing, harness the power of gravity to aid the baby’s descent into the pelvis. Frequent position changes—ideally every 30 to 60 minutes—are crucial for promoting the subtle movements needed for the baby to rotate and navigate the pelvic curves.
Squatting and deep lunges, often supported by a partner or a support bar, can increase the dimensions of the pelvic outlet by up to 20 to 30%, creating more room for the baby to pass through. For back labor, which is often associated with the baby being in a posterior position, the hands-and-knees position can help rotate the baby and relieve pressure on the spine.
Regularly emptying the bladder is important, as a full bladder can act as a physical obstruction, blocking the baby’s path through the pelvis. Tools like the peanut ball, used while lying on the side, can also help maintain pelvic opening when rest or an epidural limits upright movement.
The Importance of Psychological and Environmental Support
The physiological process of labor is exquisitely sensitive to the emotional and environmental state of the birthing person, governed by the interplay of hormones. The release of oxytocin, the hormone responsible for generating effective contractions, is easily inhibited by stress hormones like adrenaline. When a person feels fear, anxiety, or a lack of privacy, the body enters a “fight or flight” response, triggering an adrenaline surge.
The surge of adrenaline redirects blood flow away from the uterus to the major muscle groups, effectively slowing down or stopping the oxytocin-driven contractions. Creating a calm, private, and safe environment, sometimes called the “cave effect,” is critical for uninterrupted hormonal flow and labor progress.
Dimming the lights, controlling the noise level, and limiting the number of unfamiliar people in the room all contribute to a feeling of security. Continuous labor support from a doula or partner provides emotional reassurance, comfort measures, and advocacy, which reduce stress and allow oxytocin to be secreted at levels needed for a healthy, progressing labor.