Search
  • paulominiles

Fixated on time ---- "It’s time to re-examine what normal and abnormal is"


A new study published in the Green Journal (Obstetrics & Gynecology) by a group of researchers out of UCSF is getting a lot of interest. It managed to take a retrospective look at data for over 42,000 women over the course of 30 years; the split between both groups was roughly 50/50. Their main goal was to compare the length of time for the pushing stage of labor (also known as the second stage) between women who chose to have an epidural and women who did not.

The reason that this study is powerful upon first glance, is that it generates conversation and awareness among women and the obstetrics and birth professions about the pervasiveness of ceserean births for women who 'run out of time'. Based on a time vs labor progress curve, named the Friedman Curve, many physician providers are trained to expect that women without an epidural with their first baby should only be allowed to push for 2 hours, while those with may need to push for close to 3 hours. When time runs out, a woman is one inch closer to the operating room.

This study aims to shed some serious clinical light on the overuse of actively managed birth, use of pitocin and use of instruments to faciliate second stage (mostly vacuums). Women who choose epidurals are at a higher risk for cesereans and for those diagnosed with a prolonged second stage, using 2-3 hours as the norm, puts women at a even higher risk for a c- section.

If we can change the standard definitions of normal length of labor - over 30% of women could avoid unnecessary cesereans. That is a staggering number. Utlimately the article adds to our awareness of how an interventionist approache to care is not always what is best for us. And as one physician in the article eloquently states:

"Often what's best and and most appropriate - and most difficult - during labor is PATIENCE"

Copy and paste this URL intor your browser for access to the NY Times article published Feb 6, 2014

http://nyti.ms/1fTmZo3

#newyorktimeshospitalbirthsecondstageepidural

20 views