Interesting Article: Study Suggests Misplaced Fears in Longer Childbirths

JelloBean1 · February 2014

Saw this article in the New York Times today: "Study Suggests Misplaced Fears in Longer Childbirths" and thought it would be of interest here.

Link to full article: https://www.nytimes.com/2014/02/06/health/childbirth-study-sees-longer-labor-as-normal.html?_r=1

Interesting excerpts:

"Epidural anesthesia lengthens the second stage of labor, the one in which women push. But a study published on Wednesday has found that epidurals are associated with an even longer duration in the second stage than is generally recognized, suggesting that some women may be subject to unnecessary interventions by doctors who wrongly fear labor has become prolonged."

and

"“One of the messages of this study is, sit on your hands a little longer, don’t rush into an instrumental vaginal delivery or a cesarean, because really everything could be fine,” said Dr. Barbara Leighton, a professor of anesthesiology at Washington University in St. Louis School of Medicine, who has researched the effects of epidurals on labor."

wtfisup · February 2014

Not wanting to prolong labor is part of the reason I'm going unmedicated. Nothing wrong with meds, but everything I've read/heard/seen indicates that being able to move around as you please is important to helping the process. Even if the drug itself doesn't slow labor, a lot of practices (some hospitals making you stay in bed, fetal monitoring) that come adjacent aren't appealing.

But again, not judging others -- get whatever you need to extract that baby.

Mowill59 · February 2014

Very interesting. For me, I felt that the epidural did prolong labor with my son. I was induced and had an epidural; I was in labor for 22 hours and was pushing for 3. However, my SIL, had an epidural and within the next hour she was holding her daughter.

This time I am opting to try for as med-free as I can. The long labor was rough but I really hated not having control over my body. It was very stressful for me as I couldn't feel myself pushing or anything.

Unknown · February 2014

This content has been removed.

k318 · February 2014

joules235 said:
Sometimes an epidural will speed up your labor if you are in a lot of pain and having trouble progressing and dealing with the pain. Out of instinct your body will fight the pain and tense up and that can really hinder labor. Its called the fear tension pain syndrome/phenomenon. If this is the issue you are having sometimes an epidural will help simply because it allows you to relax your muscles and let the contractions do their work.

This was me. I went as long as I could without the epidural but once the pain got really bad, my anxiety was through the roof and i doubt I would have had as good of a labor and delivery without it. Four hours after getting the epidural I was pushing (I went from 4cm to fully dilated in that time) and pushed for an hour. Not bad! I also got to sleep from 4cm and woke up at 9.5 cm, which I thought was pretty awesome.

To each their own. What works for one may not work for someone else. There is no right way to have a baby.

Mztwilson · February 2014

I've given birth both ways. I think I'll opt for unmedicated this time if I can. I wasn't a big fan of the epidural

ElTrain5 · February 2014

Another issue with using epidurals is that if they do slow labor, pitocin is often used to help speed it back up, leading to stronger, longer contractions that can send baby into distress. Speaking of fetal distress, an interesting fact about continuous fetal monitoring (being attached to the machine with belts) which is required with an epidural, is that it actually poses no benefit (and actually more risk) to mom or baby than having the fetal heart rate monitored intermittently. Of course many doctors are not trained in intermittent oscillation (and many hospitals do not have the equipment/say they do not have the staffing to keep up with it) not to mention a lot of them like to keep a "legal record" via the machine to protect themselves. Here's a good article with more info on CFM vs intermittent monitoring. https://evidencebasedbirth.com/evidence-based-fetal-monitoring/

chloephoebecali · February 2014

One of my epidurals may have slowed my labor, but I'll never know. I still gave birth 6 hours later in a lot less pain. Ds was even less, maybe 4 hours (can't remember when exactly I got my epi). I will be opting for another epi since I've had great experiences, but I've never been one that planned or cared to go without. Totally a personal choice, though.

Sareynoo · February 2014

I haven't had a medicated labor before so I can't say anything about it, but I will tell you that my unmedicated labor with DD was less than 3 hours altogether. My unmedicated labor went by REALLY quickly.
I will be getting an epidural this time if I can help it though, too painful.

deepoceanmama · February 2014

I agree with PPs. One of the reasons I will try to avoid an epi is because I have heard they can slow labor. Actually, my MIL (who thinks I'm nuts for wanting unmedicated labor) said that all 3 of her epis completely stopped her contractions altogether, so she then needed a pitocin drip to get them started again.

wtfisup · February 2014

@deepoceanmama, ugh, my MIL rants so much about women who try unmedicated and how nuts they are that I'm not telling her.

nunzchucks · February 2014

For me, I got the epi right before it got bad, slept for a few hours and woke up at 7cm where I was only a fingertip beforehand. (No pintocin) 40 min later I was at 10cm and 30 min after that DD was born. Perhaps I'm a SS, but I don't think anything was slowed for me. My water broke at home if that makes any difference.

Gigi8212 · February 2014

I was induced at 1pm, got my epidural at 8pm and reached 10 cm at 3am. I think for a FTM going through induction, it was a good pace.

I did push for 3.5 hours, but I really don't think it had much, if anything to do with the epi. DD got stuck. My hips just didn't widen enough and she ended up with shoulder dystocia.

deepoceanmama · February 2014

@wtfisup, we are one.

Also, my FIL has brought up episiotomies (and the inevitability that I will, like, TOTALLY need one, stop being stupid and stubborn) more than 5 times in casual conversation. Who does that?!

ElTrain5 · February 2014

@deepoceanmama next time your FIL tells you you're going to get cut, here's a nifty chart to show him

https://thatsnothowscienceworks.wordpress.com/2011/11/15/omg-is-the-us-episiotomy-rate-really-65-95/

ncbelle · February 2014

The issue isn't so much that you shouldn't get an epidural just because it may slow labor (although that's on my list of personal reasons I choose to go without), but that many doctors don't recognize that it may slow labor and mean pushing takes longer so they are too quick to jump to a c-section for "failure to progress."

So the take-away if you do plan on an epidural is be aware that longer labor is a possibility and make sure your provider is on board with that as well (vs. jumping to a c-section when things "stall."). Just be informed of all the possible side effects and make sure your provider is up front with you as well!

deepoceanmama · February 2014

lizardbreath14 said:

deepoceanmama said:

@wtfisup, we are one.

Also, my FIL has brought up episiotomies (and the inevitability that I will, like, TOTALLY need one, stop being stupid and stubborn) more than 5 times in casual conversation. Who does that?!

I would just tell your FIL that it's rather creepy and gross for him to think about, let alone speak about, your vulva, your vagina, or ANYTHING in that region! Some people, sheesh!

I know, right? And this coming from the guy who actually used the phrase "TMI" when DH and I told him that we were trying to get pregnant last summer. Sigh.

PressLove · February 2014

ElTrain5 said:

@deepoceanmama next time your FIL tells you you're going to get cut, here's a nifty chart to show him

https://thatsnothowscienceworks.wordpress.com/2011/11/15/omg-is-the-us-episiotomy-rate-really-65-95/

I hate the mention of episiotomies! Thanks for the link.

wtfisup · February 2014

deepoceanmama said:

lizardbreath14 said:

deepoceanmama said:

@wtfisup, we are one.

Also, my FIL has brought up episiotomies (and the inevitability that I will, like, TOTALLY need one, stop being stupid and stubborn) more than 5 times in casual conversation. Who does that?!

I would just tell your FIL that it's rather creepy and gross for him to think about, let alone speak about, your vulva, your vagina, or ANYTHING in that region! Some people, sheesh!

I know, right? And this coming from the guy who actually used the phrase "TMI" when DH and I told him that we were trying to get pregnant last summer. Sigh.

My FIL asked H if he "dug his toes in" (to the mattress), because that was the only way to "make a boy." So gross.

I think generally everyone should not talk to pregnant women about episiotomies. I have never known anyone who wanted this as a pre-birth conversation topic with family. Because then everyone's thinking about your vagina-anus real estate.

allrightmeow · February 2014

ncbelle said:

The issue isn't so much that you shouldn't get an epidural just because it may slow labor (although that's on my list of personal reasons I choose to go without), but that many doctors don't recognize that it may slow labor and mean pushing takes longer so they are too quick to jump to a c-section for "failure to progress."

So the take-away if you do plan on an epidural is be aware that longer labor is a possibility and make sure your provider is on board with that as well (vs. jumping to a c-section when things "stall."). Just be informed of all the possible side effects and make sure your provider is up front with you as well!

THIS! My DD's heart rate would go down some but come back up with some contractions (which I was told by a midwife is normal). The nurses went on and on about me probably having a CS. I delivered vaginally. I plan on laboring at home longer this time before I go in.

deepoceanmama · February 2014

PressLove said:

ElTrain5 said:

@deepoceanmama next time your FIL tells you you're going to get cut, here's a nifty chart to show him

https://thatsnothowscienceworks.wordpress.com/2011/11/15/omg-is-the-us-episiotomy-rate-really-65-95/

I hate the mention of episiotomies! Thanks for the link.

Ditto this. Love that link! Thanks @Eltrain5.

MamaTree17 · February 2014

What @joules125 described is exactly what happened with me. I went 25 hours in the hospital without medication, got to 10cm, pushed for over 4 hours but my body was so tense from being in pain for so long that it just wasn't working. I got a walking epidural (since I was already fully dilated) and DD was born less than an hour later. I will still try for no medication again but like others have mentioned its more about being informed and having your doctors on board. My doctor knew how much I wanted an unmedicated, vaginal birth and worked with me while others would have pushed for a c section at that point.

LegalLadyBug · February 2014

With DD they started pitocin around 6:30am, I started pushing around 2pm and she was born at 2:30pm. For me the pitocin actually worked faster than usual. They gave me an epidural around 1:15pm because I was in so much pain and they told me based on their calculations I wasn't even in active labor yet. Well surprise surprise they checked me after they got it in and I was fully dilated with DDs head already starting to come out! So I really think it depends on the person :-/

ETA: my water broke at 2am with no contractions at all which is why they started pitocin at 6:30am. Who knows how long it would have taken without it.

b48kate · February 2014

Interesting…my big take away here is that giving birth takes time and medical professionals really need to chill out before throwing red flags everywhere.

I'm going the epidural route if possible. What can I say, I am a big fan of western medicine! That said in order to reduce the chances of a c-section I plan to:

A) Labor at home as long as possible

Say "no" to any plan of action that makes me uncomfortable or doubtful (within reason).

Pretty simple steps, but highly effective per the data I've seen.

JelloBean1 · February 2014

Internationalkate said:

Interesting…my big take away here is that giving birth takes time and medical professionals really need to chill out before throwing red flags everywhere.

I'm going the epidural route if possible. What can I say, I am a big fan of western medicine! That said in order to reduce the chances of a c-section I plan to:

A) Labor at home as long as possible
Say "no" to any plan of action that makes me uncomfortable or doubtful (within reason).

Pretty simple steps, but highly effective per the data I've seen.

Yes, that's what I took from the article as well. That labor can take a long time, and unless the health of the mother or baby are really in distress, then it's ok to wait longer instead of opting for medical intervention like forceps or c-section right away.

whoberry · February 2014

mullenem said:
I'm in the getting an epidural category. I had one with DD though that labor was a bit of a SS. I was induced due to low amniotic fluid and the induction caused my contractions to couple - two contractions back-to-back with no break - not fun. So after 3 hours of active labor, I was dilated a 5 and got my epidural. Water broke while the doc was finishing the epi and I went from a 5 to a 10 super fast at that point. Within 40 minutes of getting my epi, I started pushing and 20 minutes later DD was born.
You've got to think with the technology available, they would have made a wireless fetal monitor already...that'd be awesome. All the benefits of having constant monitoring without being "chained" to a bed.

@mullenem my hospital has wireless fetal monitoring. They are also super natural child birth oriented with jacuzzi tubs in most rooms and have the lowest c section and episiotomy rates in the region.

ElTrain5 · February 2014

Just wanted to pop back in with a clarification that "wireless" continuous fetal monitoring poses the same risks as non wireless CFM. If your interested in reducing that risk (see the article in my prior post for a better description) ask you OB or midwife about intermittent monitoring. They can do this using a portable Doppler or a fetoscope (a special kind of stethoscope). They usually check the babies heart rate every 20-30 minutes through contractions. Although if your provider refuses to do IFM, wireless gives you the added benefit of movement which has all kinds of good benefits all to itself

Sorry for being so nitpicky

just want to make sure I'm passing along the best info I can.

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Interesting Article: Study Suggests Misplaced Fears in Longer Childbirths

Re: Interesting Article: Study Suggests Misplaced Fears in Longer Childbirths

IF, 5 losses, 1 son, 1 on the way.

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