Patience after stalled labor advised
November 18th, 2008 — Kim
Another “D,” this time for Duh! All very well and nice, but this study corroborates what low-intervention care providers have always known: Nature has a design and babies come when they are ready. Patience is often the best method for managing labor. But, with imposed time tables and schedules (hospitals’, doctors’, patients’) inciting agitation among everyone when a baby isn’t born within 12 hours of the first contraction, babies will continue to be forced out based on the perceived need of someone else.
A gripe with the study: Though the mode of delivery showed no significant impact on perinatal outcomes such as the rate of admission to neonatal intensive care and 5-minute Apgar scores, lactation and breastfeeding success do not appear to have been assessed, even though it is known that they are impacted by delivery mode. These final pieces of the puzzle must be included in the evaluation of maternity care success. Until conventional medicine embraces lactation and breastfeeding as the NORMAL, BIOLOGICAL fulfillment of pregnancy and birth, and breastfeeding as a BEHAVIORAL objective of the newborn, these studies will ring hollow. It ain’t over until the postpartum lady sings, “We are breastfeeding well!”
Patience after stalled labor advised
Source: Obstetrics and Gynecology 2008; 112: 1109-15
Comparing the outcomes of vaginal versus cesarean delivery following stalling of active labor.
MedWire News: Persevering for a vaginal delivery if labor stalls during the active phase can avoid the maternal complications associated with cesarean section, with no detrimental effect on neonatal outcomes, research indicates.
“One-third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year,” said senior author Aaron Caughey (University of California, San Francisco, USA).
“In our study, we found that just by being patient, one-third of those women could have avoided the more dangerous and costly surgical approach.”
The investigators studied data on 1,014 women who experienced active phase arrest during labor. Among these women, 335 (33 percent) went on to deliver vaginally, while the rest underwent cesarean deliveries.
Analysis revealed that cesarean delivery was associated with an increased risk for maternal complications, including endomyometrisis (odds ratio = 48.4) and postpartum hemorrhage (odds ratio = 5.2). However, the mode of delivery showed no significant impact on perinatal outcomes such as the rate of admission to neonatal intensive care and 5-minute Apgar scores.
“Given the extensive data on the risk for cesarean deliveries, both during the procedure and for later births, prevention of the first cesarean delivery should be given high priority,” Caughey recommended.
© 2008 Current Medicine Group Ltd, a part of Springer Science+Business Media
http://www.greenjournal.org/cgi/content/abstract/112/5/1109