Friedman's Curve and Failure to Progress

A leading cause of unplanned Cesareans
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  • Lectures 22
  • Length 1.5 hours
  • Skill Level All Levels
  • Languages English
  • Includes Lifetime access
    30 day money back guarantee!
    Available on iOS and Android
    Certificate of Completion
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About This Course

Published 12/2013 English

Course Description

**This class offers 2 contact hours and 0.2 CEUs for nurses, doulas, childbirth educators, and nurse midwives!**

"Failure to Progress" is the number one cause of C-sections among women giving birth for the first time.

Failure to progress is a subjective diagnosis based on Friedman's Curve-- a graph that shows how fast women should dilate during labor. Although most healthcare providers still use Friedman's Curve to dictate how they manage a woman's labor, this curve was published in 1954 and has since become completely obsolete. If more healthcare providers got rid of Friedman's Curve and learned the new, evidence-based definitions of normal and abnormal labor, we would see a drastic decrease in the overall C-section rate.

You have the chance to take a class from Rebecca Dekker, the PhD-prepared founder of Evidence Based Birth, and learn the facts about Failure to Progress and Friedman's Curve.

By taking this class, you will gain non-biased information about failure to progress, failed inductions, and how to prevent slow progress in labor .

In this class you will learn:

  • Why is failure to progress such a big problem?
  • What is the history of Friedman's Curve?
  • What is the normal length of labor in modern women?
  • Can long labors lead to health problems?
  • What are the new, evidence-based definitions of labor arrest and failed induction?
  • How can we help prevent women from having long labors in the first place?

Because the class is made up of short videos, you can take the class at your own pace.

The class also includes:

  • Printable handouts for you to keep
  • MP3 audio files you can download
  • Video voice-overs that you can download to view offline
  • An interview with a woman who gave birth during Dr. Friedman's time
  • A quiz to check your knowledge
  • Three wrap-up case studies (scenarios) so you can pull everything together
  • A chance for you to ask Rebecca questions

Should you take this class?

If you are a doula, childbirth educator, nurse, nurse-midwife, midwife, physician, or highly motivated parent and you want to learn in-depth facts about Friedman's Curve and Failure to Progress, then this class is for you!

Can I earn continuing education hours?

Yes!! Rebecca has been approved as a continuing education provider by the Kentucky Board of Nursing. This means you can earn a certificate for 1.8 nursing contact hours once you complete the course. Nursing contact hours can also be applied to most doula, childbirth education, and some midwifery certifications. Note: Check with your certifying organization to ensure they accept nursing contact hours.

This course has also been approved for 0.2 ACNM CEUs by the American College of Nurse Midwives!

When does the class start?

Since the class is online, you can start anytime! And purchase of the course gives you lifetime access to the class and any updates. This means you will have plenty of time to complete the class at your leisure. And you can relax knowing that you’ll always be able to come back to the class if you want to refresh your memory.

Is there a money back guarantee?

Yes, you are provided with a 30-day money back guarantee.

How much does the class cost?

The class is just $49 for 2 hours of video content and all of your class materials– including videos, audio files, handouts, 3 wrap-up case studies, and a certificate for contact hours. You will also have the chance to join the closed Evidence Based Birth Classroom group and ask questions of the founder of Evidence Based Birth.

What are the requirements?

  • Internet connection

What am I going to get from this course?

  • Discuss the problem of "failure to progress"
  • Discuss the history of Friedman's curve
  • Describe normal labor in modern women
  • Discuss potential problems that may come from longer labors
  • Review the new definitions of labor arrest and failed induction
  • Discuss ways to help labor move along

Who is the target audience?

  • Motivated parents
  • Doulas
  • Childbirth Educators
  • Midwives
  • Nurses
  • Physicians

What you get with this course?

Not for you? No problem.
30 day money back guarantee.

Forever yours.
Lifetime access.

Learn on the go.
Desktop, iOS and Android.

Get rewarded.
Certificate of completion.


Section 1: Introduction

In this lecture you will receive an orientation to the course, an introduction to your teacher, a description of resources for you, and instructions on how to complete the class and ask questions. Check the supplementary materials section (below) for your downloadable podcasts of this class (coming soon!), as well as the printable lecture notes.

Also, all of the videos are downloadable, so if you are going to be without internet access you can download the class ahead of time and watch it later.


This background section lays the foundation for the rest of the course.

We will learn about the C-section rate in the U.S., and the two main drivers behind the rising C-section rate (primary C-sections and repeat C-sections). You will learn why it is so critical to lower the "primary" C-section rate, as well as the top causes of primary C-sections in the U.S.

To read more about the high C-section rate in the U.S., you may want to check out this article by Childbirth Connection.


In this lecture, we ask the question, "When do C-sections for failure to progress happen?" Unfortunately, a substantial number of women are diagnosed with failure to progress when they are in very early labor-- a practice that leads to many unnecessary surgeries.

Click here for a free full-text research article about C-sections for failure to progress, written using statistics from the Consortium for Safe Labor.


In this lecture we talk about the problem of failed inductions, and we will wrap up the first section of the course with a summary of the overall problem.

Section 2: What is Friedman's Curve?

In this lecture, we will cover the history of Friedman's curve, a graph that is used by most care providers when they care for women in labor. By the end of this lecture, you will be able to describe where Friedman's curve came from.


In this lecture, we will talk about the women who were in Dr. Friedman's research study in the 1950's. By the end of this lecture, you will be able to describe how women of Dr. Friedman's study are different from women who give birth today.


To give you a better idea of what it was like to be one of the women in Dr. Friedman's study, I interviewed a mother who gave birth during that era. In this interview, Carol shares with us what "twilight sleep" was like, and what it was like to give birth in a hospital during both the 1960's.... and the 1980's!! Her 4 births were spread across 3 decades and took place in 1963 (in Virginia; twilight sleep), 1968 (New Jersey; twilight sleep), 1980 (Kentucky; epidural), and 1982 (Tennessee; unmedicated birth). Enjoy listening to her fascinating journey of how she went from one extreme of birth to the other!

Section 3: What does Modern Labor Look Like?

In this lecture, we will talk about the average length of labor among modern women who go into labor on their own (not induced). By the end of this lecture, you will be able to describe the average length of the first (active) stage of labor, and the second stage of labor. You will also be able to define when active labor starts for most women.


In this lecture, we will look at some additional evidence on the length of modern labor. By the end of this lecture, you will be able to compare the modern woman's average length of labor and speed of dilation to what Dr. Friedman observed back in the 1950's.

Section 4: Are Long Labors Safe?

In this lecture, we will look at the research evidence on whether there are maternal and newborn health risks related to long first stages of labor.


In this lecture, we will talk about whether there are any maternal or newborn health risks associated with long pushing phases.


Wrapping up the section on, "Are long labors safe?" we will discuss whether there are any health problems related to long inductions.

Section 5: What Definitions should we be using for Long Labor?

In this section, we will compare and contrast the old (outdated) and new (evidence-based) definitions of failure to progress, labor dystocia, labor arrest, active labor, and failed inductions. If you have trouble downloading the PDF from the course, you can also find it at this link:

1 page

This Evidence Based Birth printable handout is for YOU to print and share with coworkers, care providers, clients, friends, and family. It compares the old and new definitions of failure to progress, labor dystocia, active labor, labor arrest, and failed inductions.

You can download the handout that is embedded in this lecture, or you can find it at this link:

Section 6: How can we help Women with Long Labors?

By the end of this lecture, you will be able to describe medical and non-medical factors that may increase or decrease the speed of labor. You will also be able to describe whether artificial rupture of membranes (breaking the water on purpose) speeds up labor.


By the end of this lecture, you will be able to describe the new preventive "Four P's" that care providers can use to help prevent slow progress in labor.

Section 7: Wrap-up

In this lecture, we will summarize the take-home points from this online class.


In this case study we will look at an example of a woman who was diagnosed with first stage labor arrest, and see if her diagnosis lines up with the current evidence-based definition. We will also look at the factors that may have contributed to her longer labor.


In this case study, we will look at a woman who was diagnosed with a failed induction, and compare her diagnosis with the new evidence-based definitions of failed induction.


In this case study, we will hear how a woman with a longer labor could have easily been diagnosed with failure to progress (according to the old definition). Was she in active labor or early labor when she was admitted to the hospital? Was the length of her labor normal? Also, please be sure to join the FREE Evidence Based Birth monthly newsletter to receive free printable handouts, an exclusive article about giving birth in the 1950's (only for newsletter subscribers), and notice about future classes!

Section 8: Course Evaluation
Course Evaluation
New! Link to Quiz and Certificate!

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Instructor Biography

Rebecca Dekker, PhD, RN, APRN, Founder of Evidence Based Birth

Rebecca L. Dekker, PhD, RN, APRN is the founder and author of the internationally-known website, Evidence Based Birth. Rebecca is an assistant professor of nursing at a research university in the U.S. She teaches pathophysiology and pharmacology to undergraduate nursing students, and she serves as a mentor for doctoral students in Nursing.

Rebecca's research has been recognized with many awards, including the Promising Young Investigator Award from the American Heart Association. Rebecca is a board-certified clinical nurse specialist and an advanced practice registered nurse.

In May 2012, Rebecca realized that it was very difficult for the average person to find information about evidence-based maternity care. Realizing that she had the research and writing skills to meet this need, Rebecca coined the term "evidence based birth" and founded Evidence Based Birth. The mission of Evidence Based Birth is to promote evidence-based practice during childbirth by providing research evidence directly to women and families.

Founding Evidence Based Birth led to new opportunities for Rebecca. In November, 2012, she joined the executive board of directors of Improving, a non-profit whose mission is to bring evidence-based care and humanity to childbirth.

Rebecca has given many presentations about evidence based birth to nursing students, medical residents, college students, and midwives. In 2013, her speaking engagements included the American College of Nurse Midwives annual conference, the Virtual International Day of the Midwife. and the March of Dimes Perinatal Professionals seminar series.

In addition to being a prolific writer, researcher, and teacher, Rebecca is wife to Dan and mother to three young children.

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