Doctors need to give healthy women more time to deliver their babies vaginally before assuming they need to have C-sections according to new guidelines published today by The American College of Obstetricians and Society for Maternal-Fetal Medicine, which reported that 1 out of 3 women in the US now deliver via caesarian sections.
“Labor takes a little longer than we may have thought, and there is no need to rush to judgment that it may have stalled,” commented Dr. Aaron Caughey, chairman of obstetrics at Oregon Health and Sciences University and the study’s co-author, who noted that while “C-sections can be life-saving for both the mother and baby, it is often being performed for the ‘wrong reasons’ such as convenience and fear of lawsuits.”
At the same time, it is important to weigh the risks involved in performing the surgery, as well as the fact that once a woman has a c-section, there is a good chance that all subsequent births will end up being delivered as Caesarians as well.
"As soon as someone is admitted to the hospital, they're kind of on the clock," Caughey said. “Yet I have found that my patients can run the gamut from 6 hours to several days from start to finish.
In fact a previous study conducted by the National Institutes of Health in 2012 determined that one particular stage of labor took to 2 1/2 hours longer now than it did in the 1960s, when many of the ‘modern” definitions of labor were established. While the difference may lie (in part) in the fact that mothers-to-be now tend to be older and weigh more, there has also been an increase in the use of epidurals, which can slow the process down.
As a result, the new guidelines suggest that obstetricians refrain from ordering a C-section simply because the first and longest phase of labor is prolonged with contractions that are mild and widely spread out. This is called the latent phase and the mother's cervix is barely dilated. Contrary to past belief that “active labor” began when the cervix became dilated to 4 centimeters, the new findings suggest that it does not really begin until the cervix is dilated to 6 centimeters. This is when “contractions become stronger and more frequent, and the cervix begins to dilate more rapidly until the woman eventually is ready to push.”
“That's an important change because many doctors won't admit women to the hospital until they're in active labor, unless they need more care for another reason,” Caughey continued. “If women aren't too tired, allow them to push at least two hours if they have delivered before, three hours if it's their first baby. They may push longer if they had an epidural as long as the doctor can see progress.
He also stated that more doctors need to be properly trained in the use of forceps, which can be a “ safe alternative to certain caesareans if used by an experienced, well-trained physician.”