How to Keep Normal Labor Normal – Part 8 – Patience

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How to Keep Normal Labor Normal – Part 8 – Patience

This blog series is designed to help women who are developing a birth plan join together with like-minded birthing professionals so as to have a shorter and safer labor and birth. Although written primarily for professional birth attendants, I hope information will be helpful to lay women planning their birth. Today we’ll look at the sixth “P” of my 10 “P’s” of keeping labor shorter and birth safer — patience.
“We’ve forgotten that most women deliver in time.  If you allow 24 hours to elapse before intervening, you wouldn’t have the high cesarean rate … we’re  not doing the combination of the right things in managing labor.”(29)  Not only are the “24-hour” or the “12-hour” rules open to debate, but the “2-hour” rule is also being questioned:  “The two-hour rule for second stage is passé.  We studied 4000 women in which we found no direct effect of the duration of second stage of labor on immediate measures of perinatal outcome of maternal morbidity.”(70)
Of interest, the literature suggests that in some cases intervention delay can be helpful.  For example, “…patients cared for by nurse midwives, who have to see a family physician before referral to an obstetrician for cesarean section, require additional time…which may have afforded the patient enough time to progress in labor and obviated the need for a cesarean section.  The implication is that a large number of cesarean sections for dystocia could be avoided if patients were allowed to labor longer.”(72)
“We’ve forgotten that most women deliver in time. If you allow 24 hours to elapse before intervening, you wouldn’t have the high cesarean rate … we’re  not doing the combination of the right things in managing labor.”(29)
Not only are the “24-hour” or the “12-hour” rules open to debate, but the “2-hour” rule is also being questioned:  “The two-hour rule for second stage is passé. We studied 4000 women in which we found no direct effect of the duration of second stage of labor on immediate measures of perinatal outcome of maternal morbidity.”(70)
Of interest, the literature suggests that in some cases intervention delay can be helpful.
For example, “… patients cared for by nurse midwives, who have to see a family physician before referral to an obstetrician for cesarean section, require additional time … which may have afforded the patient enough time to progress in labor and obviated the need for a cesarean section. The implication is that a large number of cesarean sections for dystocia could be avoided if patients were allowed to labor longer.”(72)

Citations:
(29) Hon, E. In: Young D. Crisis in obstetrics-the management of labor. Int J Childbirth Education 1987, August: 13-5.
(70) Cohen, W.  In: Young D. Crisis in obstetrics – the management of labor. Int J Childbirth Education 1987, August: 13-5.
(71) Sandmire HF, DeMott RK.  Auscultation of the fetal heart presents advantages over electronic monitoring.  Wis Med J 1995;94:661-3.
(72) Hueston WJ, Rudy MA.  A comparison of labor and delivery management between nurse midwives and family physicians.  J Fam Pract 1993;37:449-454.

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