Giving Women Just One More Hour To Push Cuts C-Section Rates In Half

by Maria Guido

Want to cut the c-section rate? Give women time to labor

A small but eye-opening study brings up a very important question about c-section rates in this country. What if we’re simply not giving women enough time to labor?

The study included 78 first time moms birthing at Thomas Jefferson University Hospital. They were split into two groups: one was given the usual time of three hours to push, the other was given an extra hour. The results? In the group that was given the usual three hour time allowance, the c-section rate was 43.2%. The women who were given an extra hour had a c-section rate of 19.4%.

If you’re wondering where the three hour guideline even comes from to begin with, The Huffington Post has an answer: “[The time recommendation] came from expert opinion from the 1800s,” said Dr. Alexis Gimovsky, a fellow in maternal fetal medicine at Thomas Jefferson University in Pennsylvania, and an author on the study. “Since then, there’s really only been retrospective data used to validate that guideline.”

Wow. There were studies in the 1950’s that looked over earlier data that proved women who delivered babies within two hours had lower rates of infection and serious bleeding. Seems we’ve been sticking with this recommendations for a long time.

“The study really showed what we’ve seen in practice for years, which is that there can be benefits to allowing women to labor longer,” said Gimovsky. “We were excited to see that it dramatically reduced the risk of C-section in this specific group of women.”

Before we turn a blind eye to the study because there are so many instances where c-sections are medically necessary — let’s acknowledge that yes, of course they are. No one is saying that they’re not. But if this study proves anything it’s that there are certain instances when women just need a little less pressure to deliver in a timely manner. It’s not surprising at all that the length of time women need in labor has changed, given that life has changed so much as well.

A federal study in 2012 proved that women were taking hours longer to give birth than they were 50 years ago: “The typical first-time mother takes 6 1/2 hours to give birth these days. Her counterpart 50 years ago labored for barely four hours.” The lead author of that study, Dr. Katherine Laughon, told NPR “The past definitions of ‘normal’ labor have been used to draw the line as to when it’s time to intervene with a cesarean delivery. But what we’ve shown is that labor is actually longer … than it was 50 years ago. That certainly calls for a reassessment of when one should draw the line for cesarean delivery.”

Meanwhile, c-section rates have climbed to 30% in this country and 10-15 percent of those take place in cases where the second stage of labor has stalled. It really makes you wonder if the pressure we put on women once they get into hospitals to deliver is seriously affecting that rate.

When I was pregnant with my first child, I was really hoping for a non-medicated, non-surgical birth. My OBGyn at the time was very supportive of what I wanted, but I’ll never forget the advice he gave me. He told me the best way to avoid interventions was to arrive at the hospital in active labor. My midwife had the same advice, warning that once you get into the hospital you’re “on the clock.”

This study was not meant to discount the medically necessary option of c-section. The aim of the study was to ensure that the recommended time in labor guidelines that so many doctors and hospitals follow are based on sound evidence — not outdated studies. Certainly the difference in c-section rates for this one small study is enough to call for wider scale studies to be performed, so we’re giving women the absolute best guidance.

What if lowering the c-section rate in this country comes down to one very simple idea…

everyone just needs to back off a little.