Study suggests misplaced fears in longer childbirths

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I am a mom of three beautiful children so I am well versed on child birth thus this article from the New York Times was quite interesting to me. Catherine Saint Louis has been on staff at The New York Times since 1999 and is currently a health reporter for the Science section. She covers oral health, pediatrics, obstetrics-gynecology issues and more.

On the subject of epidurals, researchers found that the use of that form of anesthesia, given during the second stage of labor (the time when the woman pushes), is associated with longer deliveries. The study suggested a normal second stage can take as long as 5.6 hours for first-time mothers who get epidurals and as long as 3.3 hours for those who don’t get epidurals. Until now, it had been commonly believed that an epidural only added an hour’s difference. So doctors, thinking that something was going wrong with the birth, had been stepping in with interventions, when the effect of the epidural was simply lengthening the time of the second stage. Hearing of these findings, some experts said doctors may want to adjust their approach to cutting labor short if the woman has had an epidural

Current guidelines by the American Congress of Obstetricians and Gynecologists (ACOG), define an abnormally long second stage as more than three hours for women who received an epidural and are giving birth for the first time, and more than two hours for first births without an epidural. The new study found that the second stage for these women can be as long as 4.25 hours and 1.35 hours, respectively.

Researchers at the University of California, San Francisco, analyzed the records of 42,268 women who delivered vaginally without problems between 1976 and 2008. Roughly half had epidurals.
The investigators compared the average length of the second stage of labor among women who had epidurals with that among women who did not. They also compared the upper limits of duration for both groups. Thirty-one percent of first births and 19 percent of subsequent labors would have been classified as abnormally long by the current ACOG definition, the researchers found.

The research is part of a growing body of evidence suggesting that a normal second stage of labor is now longer than it was decades ago. In 2010, a study of more than 62,000 women found it was as long as 3.6 hours for first-time mothers after an epidural, and 2.8 hours for women who did not get one. A 2012 summary of a joint meeting of ACOG and the National Institutes of Health concluded that adequate time for each labor stage œappears to be longer than traditionally estimated. For the second stage, it is closer to four hours for first-time mothers who had epidurals, and three hours for those who did not. But this latest study is the first to suggest such an extended second stage may be ordinary.

So what is the message for the expectant parents and their physicians? Be patient, sit on your hands a little bit longer. Don’t rush into starting an intervention such as a vacuum or cesarean because everything could be fine.

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