Length of Labor With Epidural

Assumption: Getting an epidural does not affect the length of labor in most women.

FALSE
This new (2014) study confirms that for most women, an epidural adds about 2 hours to the length of a normal labor prior to vaginal birth.  The study reviewed the cases of over 42,000 births and compared the length of the second stage of labor (the pushing stage).  The authors point out that standard practice is to intervene when stage 2 is one hour longer than a “normal” labor.  This study indicates that maybe more time should be given before medical intervention is begun.

http://journals.lww.com/greenjournal/Abstract/publishahead/Second_Stage_of_Labor_and_Epidural_Use__A_Larger.99536.aspx

My Views:
I realize than many women will choose a longer labor without the pain to a shorter labor with the pain, but I think it is only fair to tell women they may be extending the time of their labor so they can make that choice themselves.  It would also be wise for the medical practitioners to give as much time as possible to the laboring woman if baby and mom are healthy.  Beginning interventions just based on the clock may be causing unnecessary interventions, including cesarean sections.  So, with this study in mind, if the clock does remain important, maybe they could extend the “expectant management” (waiting and watching) time to 2 hours instead of 1 to give women a better chance to birth their babies vaginally and without expensive and intrusive interventions.

Wait for Labor to Start on its Own

Assumption: Spontaneous labor is better for mother and baby, if no complications are present during pregnancy.

TRUE
This study of women with low-risk pregnancies and no complications demonstrates that elective induction (inducing labor without medical cause) and elective cesarean surgery (cesarean without medical cause) can lead to more adverse outcomes than waiting for labor to begin on its own.  In the case of induction of women with no prior births, they were 2.7 times more likely to have an unplanned cesarean.  First time moms and those who had given birth before were both more likely to have postpartum complications.  Women who had prior births and chose to have cesarean surgery were more likely to have postpartum complications.  Rates of NICU (neonatal intensive care unit) admission and administration of oxygen for the baby were elevated in women who chose cesarean surgery.

http://www.ncbi.nlm.nih.gov/pubmed/20085677

My Views:
I am not surprised by these results.  The timing of labor is set by the baby’s readiness to be born and if the baby has not yet given the “signal” to the hormones that start labor, it makes sense that the baby would need more care and may not always be completely ready for birth.  It also stands to reason that the body would not be at its most efficient if it is not ready to go into labor.  A woman’s body starts preparing for labor some time before the labor actually starts and if it has not had time to go through the changes and preparations needed, labor could reasonably be more difficult and not progress as smoothly.

Oxytocin and Baby’s Brain

Assumption: Maternal oxytocin benefits mom, but has no direct effect on baby.

FALSE
(Note: The featured study was done on rats, so further research is needed to see if it is true for human brains.)  It appears from this study that oxytocin, the hormone that governs labor,  breastfeeding, and attachment; has a direct affect on a baby’s brain.  During birth, when the baby puts pressure on the cervix, oxytocin is released and the baby receives the hormone through the placenta.  The oxytocin appears to actually slow down the brain and “silence” nerve cells.  Because of this affect, birth itself has less of a traumatic effect on the baby and the baby can actually tolerate oxygen deprivation for up to an hour because the energy needs are reduced.

http://www.sciencemag.org/content/314/5806/1788

My Views:
What a neat finding!  I love it when the researchers discover more ways in which our bodies help us.  One hormone that can do so many positive things… and more being discovered!  It is truly amazing the many ways in which moms and babies are connected physically as well as emotionally.  And oxytocin is involved in both!  It is also important to note that synthetic oxytocin (pitocin) is not the same as naturally occuring oxytocin.  Maybe that gives me a topic to research for later this week!

Cord Prolapse

Assumption: Walking can cause umbilical cord prolapse (cord coming out before the baby) if waters have broken.

UNPROVEN
Risk factors for cord prolapse include low birth-weight, prematurity (presumably because of small size), breech or transverse presentation (upside down or sideways baby), polyhydramnios (an excessive amount of amniotic fluid) and premature rupture of membranes (water breaking before baby is engaged)

http://www.ncbi.nlm.nih.gov/pubmed/16538441

My Views:
When a client told me she was required to remain in bed (no walking) during during almost all of her labor because her water had broken and they did not want the cord to “fall out,” I was intrigued.  (I often use my clients’ experiences to enhance my own learning about birth!)  I knew that the gush of the breaking water could bring the cord down if the baby was not engaged, but I wondered if, in fact, walking (gravity) would bring the cord down on its own.  I’ve been researching this topic for several days and I have found no evidence that this happens.  However, I also found no evidence that it does not.  What I *did* find is that typing “cord prolapse” into Google results in a great number of websites for … LAWYERS.  These lawyers are apparently anxious to sue any doctor whose patient’s baby experiences complications (often cerebral palsey or death) of cord prolapse.  I guess we can all draw our own conclusions from there.

Food and Drink Restrictions

Assumption: Women in labor should not eat or drink.

FALSE
These protocols were put in place when women would have to be put under general anesthesia regularly when complications arose (1940s).  Now that there have been such advances in anesthesia, there are no proven benefits to withholding food and drinks during a normal, low-risk labor, and studies have shown that it can actually prolong labor.

http://www2.cochrane.org/reviews/en/ab003930.html

This 2013 review of studies that include over 3,000 women concludes, “Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications.”

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003930.pub3/abstract

My Views:
It just makes sense that if a woman needs strength for the marathon that labor can be, she should be allowed to consume food and drink.  Hydration is also important and ice chips are not quite the same as a real drink of water!!  As far as I know, out-of-hospital births routinely involve keeping moms well fed and well hydrated, but in-hospital births usually require an IV for hydration.

Oxytocin for Slow Labor

Assumption: Use of oxytocin during a slowed first stage of labor will lead to faster delivery.

TRUE
In studies of women whose labor had slowed during stage 1, oxytocin did shorten labor by an average of 2 hours.  It did not, however decrease cesarean rates or the use of instruments for delivery.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007123.pub2/abstract;jsessionid=0585DF03B4CB07EB66607F015F19E331.d01t01

My Views:
As people look at the high cesarean section rate in our country, many try to find reasons it is so high.  Some have theorized that if slow labor was augmented by oxytocin the shorter labor would mean fewer surgical births would be necessary.  While the oxytocin did tend to shorten labor, there was no difference in cesarean rates.  That indicates to me that length of labor is not usually the cause of the cesarean delivery in cases of slow progression and that we need to keep looking!

Epidural Pain Relief

Assumption: Epidural analgesia relieves pain during childbirth with no adverse affects.

FALSE
According to studies, epidural analgesia does usually relieve pain during childbirth.  However, using an epidural often led to longer labor, stalled labor, and low blood pressure.  After the birth, women who used epidurals had more problems passing urine, moving comfortably, and were more likely to have a fever than women who did not use epidural analgesia.

http://www2.cochrane.org/reviews/en/ab000331.html

My Views:
Many women feel that the pain relief is worth these relatively minor effects.  Others do not want to experience the effects and decide instead to pursue other forms of pain relief.  The answer to the epidural/ no epidural question is as unique as each woman who answers it.  The only thing I recommend for ALL women is to know the possible effects before agreeing to the procedure.  Knowledge will empower you and help you make the decision that is right for you, your baby, and your family.