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.