When it comes to delivering a baby, there a many commonalities but in reality no two women’s experiences are the same. We’re told that a first baby can take 24 hours of labor, yet some women go into labor and delivering in a fraction of that time. In the past several years, there has been a noticeable uptick in the number of C-section deliveries. Putting aside the emergencies, there are many women who are opting for a C-section as a way of having a delivery they can “depend on.” Now new guidelines are being issued to doctors to encourage them to steer their patients towards a vaginal delivery. Yes, it could take longer and yes, it could be more painful but the benefits for the baby could outweigh the temporary complications.
“Labor takes a little longer than we may have thought,” said Dr. Aaron Caughey to the AP. He is the co-author of the new guidelines prepared for the American College of Obstetricians and Gynecologists. Dr. Caughey is joined by the ACOG and the Society for Maternal-Fetal Medicine, to declare that C-sections are being overused.
In America, the C-section rate is around 1 in 3. There are indeed emergencies where a C-section can be a life-saving measure. However, too many of these procedures are being scheduled for convenience.
There is also the fear of a lawsuit that generates all the C-section requests. Because a C-section is a kind of “by-the-book” operation there are rarely any complications. However, having a C-section increases the risk that the next baby will also have to be delivered by C-section.
According to the ACOG study, one of the primary reasons that doctors trigger a C-section is because they perceive that labor is taking too long. The truth is that no one can accurately predict how long labor should take. As long as the cervix is dilating and the baby or mother are not at risk, then labor should be looked at as a marathon not a sprint.
“My patients ask this every day,” said Dr. Caughey. “It can run the gamut from six hours long, start to finish, to three and four days.”
Obviously, when mom is in the hospital during labor she is being closely watched. However, the information regarding the different stages of labor have evolved over the years. It could be that a doctor with lots of experience might not be up to date on the new research. For instance, a 2012 study from the National Institutes of Health uncovered statistics that showed a specific labor stage could take upwards of 2 hours longer than what was previously understood. Contributing factors could be added weight of the mom, her age and the use of epidurals that can slow down the entire show.
Here are the recommendation take-aways from the new study:
- Don’t order a C-section during a protracted first phase of labor. This is the phase that could last longer than the 20 hours for first-time moms, which was previously the baseline.
- Active Labor could actually begin at a cervix dilation of 6 cm not 4 cm.
- Women can push for up to two hours of active labor for a second baby and three hours for a first baby. With the epidural, the pushing can go on even longer.
This slow down approach is welcome news to groups like Lamaze International who have long advocated for vaginal deliveries. They advise that moms ask about their doctor’s cesarean rate and what their feelings on the duration of the various labor phases before committing to a C-section. There are plenty of alternatives to put to work before the operation. In the end, the pain of a healthy vaginal delivery is quickly forgotten and replaced with the joy of welcoming the new member of the family.