Guess What? Longer Labors Are Totally Normal
As the night threatened to turn into day, the doctor on call ran his hands through his hair.
“I don't have a good feeling about this one,” he said ruefully. “I think she's going to end up with the slice … “
It was approximately 2 o'clock in the morning, and my patient's labor had dragged and stalled for what felt like days. She wasn't uncomfortable, and the baby wasn't in any dire distress, but the doctor's lack of faith spurred me into action. When he told her to be prepared for a c-section, I sprung into action.
I hurried into the room as he walked briskly out and gave my best pep talk. “You can do this!” I said. “There is nothing wrong with you or your body—let's prove him wrong!”
And we pushed. And pushed. And pushed some more. Both of us were exhausted but triumphant when it became clear that the birth of her baby girl was imminent. I called the doctor into the room and felt a moment of pride when he shook his head in disbelief.
“Wow!” he exclaimed. “You did it! All right—now let's get this kid out!”
So what exactly caused her doctor's misgivings that night? Was it a baby on the verge of a disaster? An emergency just waiting to happen? A mother too exhausted to go on?
It was none of those things. His leanings towards a c-section had to do with one reason and one reason only:
Her labor was taking too long.
“Timelines” for what is generally acceptable for a woman's labor are common, yet unofficial beliefs that are held among doctors and women's healthcare staff. Although it's widely known that labor can be predictable or long lasting, especially for first-time mothers, many doctors still hold onto a timeline.
With the doctor I worked with, there was no real reason that he should have doubted his patient's ability to give birth vaginally. He simply thought her long labor was a sign that something was wrong.
But as it turns out, just as he was wrong that night, doctors everywhere may have to rethink their fears and realize that longer labors are totally normal.
The New York Times recently reported on a new study that looked at the second stage of labor when a woman is pushing—the stage that is generally thought of as the “fast” stage. Current guidelines maintain that a woman in the second stage of labor should be able to push her baby out within three hours (usually two) if she has an epidural and within two hours if she does not have an epidural. And if a woman isn't able to push her baby out in the “recommended” time? You guessed it—she's usually heading for an “emergency” c-section.
Epidurals can dull a woman's sensation for pushing and block her muscles needed for pushing, hence the delay in the two groups. The guidelines are meant as a safety standard. The thought process is that the longer a woman pushes, the more her baby is deprived of oxygen with each contraction, putting the baby at risk for long-term damage.
But another study showed that those guidelines may actually be totally unfounded.
The new study found that instead of the three hours with an epidural for a first-time mother, a normal second stage of labor could actually last up to almost six hours.
That's a huge difference. And although I definitely don't want to be that mother pushing for six hours, it is an interesting concept that doctors need to be aware of—and it might avoid a lot of unnecessary c-sections.
How long did you push for? Did you have an epidural while pushing?