Doctors Advise Longer Labor to Avoid C-Sections


How long did your labor take—or should it take? I’ve had three natural births in Rome, as in no epidurals, and the main reason I chose to forgo medication was because I was so worried about this very situation. I was afraid that with an epidural, labor wouldn’t progress fast enough to suit the Italian medical guidelines and I’d end up with a C-section, possibly times three.

I didn’t realize the same thing could’ve easily happened here in the U.S. until I read NPR’s recent reported on new birthing guidelines. Obstetricians hope they will reduce the number of C-sections—and they’re all about timing.

“Women with low-risk pregnancies should be allowed to spend more time in labor, to reduce the risk of having an unnecessary C-section, the nation’s obstetricians say.”

The change comes, according to the piece, because about one-third of all births are cesareans, which is a 60 percent increase since the 1990s—though neither the health benefits (nor safety) of the mothers or infants reflect this increase.  Birth hasn’t become safer, it’s become more surgical, and doctors are now saying they’d like to reverse that.

“Women giving birth for the first time should be allowed to push for at least three hours, the guidelines say. And if epidural anesthesia is used, they can push even longer. Techniques such as forceps are also recommended to help with vaginal delivery.”

As an American in Italy, I was lucky to have a private OBGYN who came to the clinic with me (and delivered my second daughter at home,) but he was strict about not arriving at the clinic too early for fear of a C-section for no other reason than labor taking longer than the hospital’s guidelines permitted. I only traveled to the clinic at the onset of “active labor”.

This was distinguished by checking my cervix (4 centimeters was the magic number), plus a less scientific method. In the throes of labor with my third baby, we called the doctor as my contractions became regular and strong. When I answered the door (yes, he came to our house) he took one look at me and said, “You’re not in labor. You wouldn’t be standing here like that.” So we waited. And he was right. We didn’t go to the clinic until the following morning. And our son was born later that afternoon.

The new American guidelines take this even further, as the piece says, “Early labor should also be given more time, the doctors say, with the start of active labor redefined to cervical dilation of 6 centimeters, rather than 4.”

Childbirth, at least in my experience, is a long process. The first time it started at a movie theater, where I lost my mucus plug during a trip to the ladies’ room. Not knowing what to expect, I wondered if the baby would arrive within minutes. Should we even stay for the end of “Gran Torino”? The answer was yes, because our daughter was delivered at 11am the following morning. The second time my water broke at midnight, another trip to the loo (you pregnant ladies know what a repeat customer you become in the final stages) and again, the baby was born about 24 hours later. And the active part?

Even without epidurals, which sometimes slow the process, took 4, 2 and 6 hours with each child. Only one of those falls within the soon-to-be outdated guidelines, meaning I might have had at last two C-sections by now.

Now we’re in the States and with my fourth baby on the way, and an epidural planned, I’m expecting to labor at home again for as long as I can, then ask the on-call doctor about taking as much time as I need. In the meantime, you can be sure I’ll mention this report at my next visit.

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