Giving women more time to labour can reduce C-section numbers by half, says study

When Chanchal Mehta, 29, reached the hospital for delivery, her labour lasted for about two hours. Post which, she was unceremoniously taken for a C-section. Mehta was informed later that had she continued to labour for more hours, she could've put herself and the baby's life in danger.

Although Mehta delivered a healthy boy, she, like many mothers was given minimum time to labour and underwent a surgical procedure.

In fact, a 2014 report published by QZ, it was reported that up until 2010, the percentage of cesarean section was 8.5 percent (below the recommended WHO level of 10-15 percent). But in the last few years, the numbers have increased drastically, reaching as high as 41 percent of deliveries in Kerala, and 58 percent in Tamil Nadu.

These numbers also reflect the psyche of scalpel-happy private hospitals that put the woman under the knife before she completes three hours of labour during the second stage, either to reduce time (of labour) or in some cases to elicit more money.

However, a new study claims that if women are given around four hours to labour during the second stage, it can halve the numbers of cesarean section.

What the study says

Published in the March issue of the American Journal of Obstetrics and Gynecology — the study was conducted by researchers at the Thomas Jefferson University in Pennsylvania, US. They observed that it is during the second stage of labour — when the woman pushes, then finally delivers her baby — is among the most intense stretches of the procedure.

The researchers also accounted for the fact that babies are now taking longer to come out than they did in their grandma's time.

Based on this observation, they made the following revelations:

• While first-time mothers were on an average given around three hours to labour, when they were given just one more hour to push, C-section rates went down by roughly half.
• The American College of Obstetricians and Gynecologists says that during this second stage; first-time mothers generally have three hours to push their baby out if they’ve had an epidural. Beyond that, they’re thought to be experiencing a prolonged second stage of labour. This may result in healthcare providers going for a C-section, or an assisted delivery with a vacuum or forceps.
• Overall, 43.2 percent of the women who were given three hours to push ended up having a C-section.
• Just 19.5 percent of the women who were laboured for four hours had a C-section.

Participants of the study

This new study included 78 first-time mothers who delivered at the Thomas Jefferson University Hospital. These women were randomly assigned with the usual window of three hours, or allowed an extra hour to push. (These only included women who took epidural, because researchers simply could not find patients who did not get the pain medications.)

Why C-sections are performed?

Although the study proves that women ought to be given more time during their second stage of labour, there are many cases where women may actually need a C-section. While WHO guidelines recommends 8.5 percent, Indian C-section numbers are increasing by the day.

Since there are two types of C-sections (elective and emergency), you must understand why you would need an emergency surgical procedure. Here are some of the primary reasons:

• Baby is not getting enough oxygen
• Labour is not progressing
• Baby or babies are in an abnormal position
• There is a problem with the umbilical cord
• Mother is carrying more than two babies
• Mother suffers from placental insufficiency
• Fibroid obstruction in the birth canal
• Birth passage is too small and the baby is big
• Complication during pregnancy
• Baby's heart beat maybe irregular

Although these are primary reasons for an emergency C-section, you must discuss the possibilities of the birth with your doctor. It is advisable that you have a birth plan but are also prepared for an emergency situation.

Alexis Gimovsky, the fellow in maternal foetal medicine and author of this study, spoke to The Huffington Post and stated, "A woman can have a conversation with her doctor during labour if the primary reason for a C-section is the length of time ... it’s OK to ask to see if you’re a candidate for waiting longer,” she said.

Expert speaks to theAsianparent

We quizzed Dr Preeti Raheja, consultant gynecologist, Paras Bliss Hospital, New Delhi, on the subject and she explained that giving more time to labour is actually instrumental in natural child birth.

"The recent guidelines provided by American College of Obstetricians and Gynecologists (ACOG) recommended health workers to give an extra hour of trial to patients in second stage of labour after careful assessment of maternal and foetal condition. There has been w sharp increase in the number of patients undergoing C-section. This recommendation will significantly reduce the rates of C-section," she says.

She added that as an expert she herself would recommend giving more labour time to women. "I would recommend it after close assessment of foetal and maternal condition. Only if there is no foetal distress, no excessive caput formation, no excessive moulding, uterine contractions are normal, and mother is not exhausted. Also keeping in mind that prolongation can lead to abruption, postpartum hemorrhage and infection," she says.

Be sure to check out theAsianparent Community for more insightful stories, questions, and answers from parents and experts alike. If you have any insights, questions or comments regarding the topic, please share them in our Comment box below.

(Image courtesy: Medscape, Medicaldaily)