The measure has very limited exclusions.
There should be more maternal exclusions such as Hx of stroke, AMI, uncontrolled diabetes, prolonged ROM, and other dx that may make a clinician or patient feel unsafe to labor

Long laboring periods and failure to descend is not addressed
Maternal exhaustion from long labors and long hours of pushing is complicating this measure.

Fetal exclusions: more anomalies should be allowed.