Let Them Labor Laboriously, If You Are Comfortable You May have To Be More Patient In Labor

Labor used to be laborious, but we actually have changed that for many women. This is affecting how your obstetrician interprets how you are progressing in your labor. On any given day in the labor wards of hospitals all over the US are mothers smiling as they labor. Of course they are smiling because their beautiful babies to be may have his smile, or mom's eyes, or grandpa's mischievous bent; but more than one or two of the moms are blissfully laboring with the benefit of modern management. Epidurals, birthing Jacuzzis, trigger point massage, beds that will go into any position but a physical flip and pretty much an array of  comforts that 50 years ago no one even dreamed of. So the Consortium For Safe Labor began to think, with all these changes, are the normal labor progress standards still accurate, or do they need a bit of modernizing as well? Your gyno will be checking her watch if this is your first baby and you are not moving a full 1.2 cm per hour in that active (past 4 cm dilatation) phase, and if you already had some know how and this is baby #2 or more, you best be moving 1.5 cm per hour. Well, actually, in obstetrics, we have to realize, we've brought more than birthing balls to the table, when we are discussing what's changed in 50 years. This new study lead by Dr. Jun Zhang showed moms are older and a bit heavier. Their study had almost a quarter of a million women, so very robust. Over 80% got epidural anesthesia and about half got some oxytocin to help the contractions. And oddly, it might take over 6 hours to just go from 4 to 5 cm and then 3 hours to get to 6 cm. And in the pushing phase the labors were much slower also, often taking 3 or 3 and a half hours for moms with first babies. In fact we've always called the active phase at starting around 4 cm as long as the cervix is at least 90% thinned out, or else at 5 cm dilated at the latest, regardless of how thinned the cervix actually is. But in this study the active phase often began at 6 cm. Actually about half entered the active phase a the traditional 4 cm, many fewer than we usually assume. Traditionally the curve of labor has been used in two ways. In the US to decide when to do a C-section, and  in some of the highest risk places to birth on Earth (sub-Saharan Africa) falling off the labor curve is used to alert of possible dire problems to try to prevent deaths (death rates in these parts for birthing is 1/22 vs 1/48,000 for Ireland for instance). And the curve is getting some "only passing" grades on both accounts. C-sections can possibly be avoided (some) if we are more patient, and just the labor curve cannot solve the more serious issues that are causing risky births in these third world countries. So once again, not one size fits all, and yet, the research should be able to tell your gyno what size fits you!


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