By: 4 April 2016
Allowing women to extend labour reduces rate of caesarean delivery

Allowing women to extend labour reduces rate of caesarean delivery

When women in labour are given more time to deliver their baby than current guidelines recommend, their incidence of caesarean delivery drops by 55 per cent, say researchers at Thomas Jefferson University.

Their study, in the March issue of the American Journal of Obstetrics and Gynecology, is the first to formally test what happens when women in the second stage of labour (fully dilated) are given four hours, instead of three, if they did have an epidural.

Not only was the incidence of caesarean delivery reduced by more than 50 per cent, there were no associated negative health consequences to the mother or child, says the study’s lead author, Alexis C. Gimovsky, a Maternal Fetal Medicine Fellow at The Sidney Kimmel Medical College of Thomas Jefferson University.

The findings suggest that the two-hour rule, which dates back to the 1800s, needs to updated, she says. “This was a small study, so a formal change in guidelines should be based on a larger sample of women. But this study shows what we have observed in practice — there is benefit to allowing women to labour longer.”

The current guidelines do allow some flexibility so some obstetricians already provide extra time to labor, on a case-by-case basis, Gimovsky says. “But, for the sake of reducing the number of caesareans that are performed in this country, we should further investigate expanding the time frame.”

About 30 per cent of deliveries in the US end with a caesarean, which can put a woman at risk for a number of complications in following pregnancies, can impact fetal health, and which are very costly, she says.

About 10-15 per cent of the cesareans for first time mothers result from the two-hour rule, she adds. Allowing three hours if a woman has had an epidural — medicine that relieves labour pain by blocking nerve signals — was added on to labour guidelines by the American College of Obstetricians and Gynecologists in the 1980s.

In this study, Gimovsky and the study’s senior author, Vincenzo Berghella, Director of Maternal Fetal Medicine at Thomas Jefferson University Hospital, enrolled 78 first time mothers who were between 36-41 weeks of gestation. They were randomised to an “extended labour” group that allowed for at least one additional hour of labour, or to a “usual labour” group that followed current delivery guidelines. At time of delivery, all of the study participants chose to have an epidural. Almost half of the women had an induced labour.

They found that incidence of caesarean delivery was about 19.5 per cent (8 out of 41 women) in the extended labour group and about 43 per cent (16 of 37 women) in the usual labour group. There were no statistically significant differences in maternal or neonatal morbidity outcomes between the groups.

Gimovsky noted that many expecting mothers were eager to join the study, suggesting “a majority of women are highly motivated to have a vaginal delivery,” she says. “Changing the guidelines may help many women reach that goal.”

Article Reference: A. Gimovsky and V. Berghella, “42: Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines,” Am J Obstet Gynecol,DOI: 10.1016/j.ajog.2015.12.042 , 2016

Source: Thomas Jefferson University