What’s the rush?

After a mom has reached the definition of “active labor” which includes that her cervix is over 4 cm (although many women can walk around for weeks at or over 4 cm dilation), if she ever goes longer than 2 hours without cervical change, she is likely to be diagnosed with “stalled labor” and wheeled off for a C-section. Apparently doctors think it is impossible for a woman to have a plateau in dilation and then start again, although many if not most midwives will recognize that this is a “variation of normal” and as long as everything is going along well with mother and baby (specifically, unless the mother requests a C-section, or the baby’s heartrate becomes “non-reassuring”, or something along those lines), midwives are content to wait.

If you haven’t seen it yet, you really need to watch this video clip, in which a doctor discusses a study they undertook at his hospital which looked at whether stalled or arrested labor is really an indication for C-section, in the absence of other factors. The short version is that as long as the baby was tolerating the labor, there was no need to rush — many moms in the “stalled labor” group went on to progress to full dilation and have a vaginal birth, sparing themselves and their babies from a C-section and recovery. Not only did moms as a group did better with vaginal birth than Cesarean (no surprise there!), but the vaginally-born babies were not harmed by their “extended stay” in utero. Actually, since the World Health Organization’s “Safe Motherhood” guidelines say that for normal, healthy women without complications, vaginal exams should be limited to every four hours, getting checked every hour or even every two hours may just be too much. I wonder how many moms have been told that they had stalled labor because they were checked every hour, when if they had had four hours between checks would have had more dilation. But too many women aren’t being given four hours — they’re being told that a plateau in dilation equals a Cesarean, and they believe what they are told.

This reminds me of what my Bradley instructor said probably every class, if not several times during class: “Is mom okay? Is baby okay? Then why can’t we wait?” Apparently, we can!

Oh, and for what it’s worth, my sister had a “stalled labor” in her second birth — she was at 6 cm dilation for 9 hours — and went on to have a normal vaginal birth (only pushed 5 minutes, too… but then, her longest pushing phase was 20 minutes), so stuff like this happens. And considering the benefits of vaginal birth over Cesarean for both mom and baby, as long as mom and baby are tolerating labor fine, why the rush?

2 Responses

  1. Stalled labor is exactly what my OB tried to pin on me, followed by pushing for a AROM or Pitocin. I consented to neither and she continued to insist I was stalled and would end up with a C-section if I didn’t let her intervene. Luckily I had taken birthing classes (Bradley) and had read many books about normal birth and the problems within the current maternity system and knew that I was not stalled and that the interventions would likely cause more harm than good. We finally got smart and sent her away to be replaced by one of the practice’s midwives. She was amazing and I will NEVER go back to an OB unless it truly is an emergency or high risk situation (and since I am actually educated about pregnancy and birth unlike many other mamas out there, I would actually know when to do this…plus, by having a good care provider, I know my midwife would never push for a change in care unless it really was necessary). Oh, and the best part of the story…less than an hour after the OB told me I was stalled and would end up with a C-section, my beautiful baby was born…vaginally! Shows you how much evidence based medicine was actually being practiced by that doctor that day. 🙂

  2. I’m a very slow progressor up to 8 centimeters. In both my pregnancies, the road to 8 was long and hard (second baby 23.5 hours from onset of labor to 8 centimeters). However, with both, I went from 8 to baby in 20-30 minutes.

    My little sister had a “failure to progress” c-section, 15 hours after her water broke and only 4 hours after they started pitocin. My true diagnosis is that it was 10:00 at night and the doctor wanted to go home.

    My mother and other sisters are slow progressors as well. I just wish we could have all shoved our medical records under my little sister’s OB’s nose and said, “look! We stall. We go slow. But when baby is read to come out, the baby will come out!”

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