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Thursday
May032012

Labor Taking Longer Today

It’s been all over the news, “Babies Take Longer to Come Out Than They Did in Grandma’s Day,” the National Institute of Health’s study (“NIH study finds women spend longer in labor now than 50 years ago”) that looked at birth practices in the early 1960’s and compared it to those in the early 2000’s… a 50 year spread. Among the findings are that labor in the (1960’s) historical group was 2.6 hours shorter in first-time moms than the (2000’s) contemporary group. Subsequent labors were 2 hours shorter in the 1960’s group.

The quick run-down is women are older when they’re having their babies, episiotomies are done far less frequently, forceps are also done less frequently and that cesareans are utilized 4 times as often as the historical group… from 3% to 12%.

Wait a minute. A 12% cesarean rate in the early 2000’s? Where in the world would that have been? I cannot fathom that is here in the United States. Jill from Unnecesarean will know for sure, but wasn’t it about 30% back then? What does that make it… 10 times the number of cesareans as in the 1960’s? And today… we’re at 40% - 50% in plenty of places, making the percentage between the two cohorts even larger.

The study minimally looked at why the labors would be longer, including epidurals, but oxytocin was used much more in the contemporary group, one would think making up for the lost time with the epidural, but that didn’t happen.

So why have labors slowed down? I have my own theories.

Women go to the hospital a lot sooner than they used to. If women presented under 4cm in the olden days, they were sent back home and told to come back later. Now, if a woman’s having even prodromal (not changing the cervix) contractions, it’s more likely she will be kept than sent home. I’m sure liability is the major reason why this happens. If something happened to the baby in the interim between presenting at L&D and then finally being admitted many hours later, the hospital would be in serious trouble for sending the mom home. In fact, that happened in the UK with a mom (looking for the link).

When I first started attending births in 1983, women who went to the hospital and were found to be 3-4 centimeters, were sent out walking for two to three hours before they were checked again. If there were changes, then they were admitted. If there weren’t changes, they were sent home. That pattern was followed until the early 90’s (in my experience). That was when women started being admitted sooner and sooner, even if it was obvious their labors had barely begun. Now, if a woman is sent out walking, she wants to know why she isn’t admitted, somehow thinking if she’s in the hospital, things will move faster.

Is that why Pitocin is used so often, too? Maternal expectations? I wouldn’t doubt if it had a hand in the escalating use of the artificial hormone.

It can be frustrating for doulas who know their clients aren’t in active labor, yet the client wants them by their sides. That can make for an enormously long time with a woman, tiring her (the doula) out long before she would really be needed in labor. I’ve seen this time and time again. I’ve taken to saying, “Once you’re in active labor I will remain with you continually” and that has virtually eliminated the marathon labor sitting and giving the mom room to be self-soothing. Of course, I am always available to chat/text/talk and even visit, but being with a mom from prodromal labor on is ridiculous.

So, what isn’t explained in all the articles is the definition of what “labor” includes… what’s the dilation at admittance? Has there been spontaneous rupture of membranes? Was there artificial rupture of membranes on admission? And probably the largest question: What is the dilation that’s considered active? 3? 4? 6 (which is the newest definition… one that I adore!)? For many years, 1-3cm was early labor, 4-6, active and 7-10 transition. If that was standardized between the comparison groups, it would make the gathered information more relevant.

I’d love to hear from long-time L&D nurses, why they felt labors are longer now. Just like the study, I don’t know the exact reasons, but I think those of us in birth have a pretty good idea why. Women haven’t changed, but maternity care sure has.

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    - Navelgazing Midwife Blog - Labor Taking Longer Today
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Reader Comments (5)

I love the 6cm definition of active labor as well. Primips get "stuck" at 4-5 cm so often! My personal theory on why the length of labor is increasing is due to malpresentations that epidurals cause. That's my own personal issue with epidurals--I think they produce asynclitic and posterior babies that take longer to rotate/or are unable to rotate. That combined with the increasing size of American babies creates more pelvic fit problems. Of course you can help mitigate that with frequent position changes, use of the "corkscrew"/extended lateral positions etc, but I know that not all nurses are either inclined or able to do that with staffing challenges.

May 3, 2012 | Unregistered Commentercileag

It took a year of doula work before I would confidently look at or talk to a client and say I'm not coming over/I'm going home for a bit when they're in early labor. The problem I have is that despite the conversations we have about not going early, about waiting until the contractions are long, strong and close for an hour they almost always leave too early and then call me on the way to hospital. Frequently it's the mom who is calling, cheerful between contractions. Drives me batty.

Cileag: I think you're absolutely right. I should have mentioned malpresentation... and persistant malpresentation... because of epidurals which weren't a part of birth all those years ago. Thanks for the reminder.

May 4, 2012 | Registered CommenterNavelgazing Midwife

Jennifer: Ayup. And ditto.

May 4, 2012 | Registered CommenterNavelgazing Midwife

Reading the link I wasn't clear on the demographics of the subjects. Is this a U.S study?

I ask because of the change in lifestyle over the past 5o years; women are less physically active (overall) than they used to be. I often wonder if the strength of the pelvic floor has changed, demographically, and if that effects second stage labor. (Anecdotally, my easiest pushing stage was my 2nd birth, which pregnancy I walked nearly every night. The following two-- after pregnancies in which I was less and less active-- were progressively worse pushing stages. I do tend toward OP babies, though, so it might just be personal.)

May 6, 2012 | Unregistered CommenterCorita

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