Patience when labor stalls 2008 Caughey

Researcher Aaron Caughey finds giving more time will reduce 400,000 cesareans a year. See the Nov. 18, 2008 Orgyn.com article called Patience after stall in labor advised. Read the research itself. Obstetrics and Gynecology 2008; 112: 1109-15 Perinatal Outcomes in the setting of active phase arrest in labor.

 

From the abstract at PubMed:

We identified 1,014 women with active phase arrest: 33% (335) went on to deliver vaginally, and the rest had cesarean deliveries. Cesarean delivery was associated with an increased risk of chorioamnionitis (adjusted odds ratio [aOR] 3.37, 95% confidence interval [CI] 2.21-5.15), endomyometritis (aOR 48.41, 95% CI 6.61-354), postpartum hemorrhage (aOR 5.18, 95% CI 3.42-7.85), and severe postpartum hemorrhage (aOR 14.97, 95% CI 1.77-126). There were no differences in adverse neonatal outcomes. Among women who delivered vaginally, women with active phase arrest had significantly increased odds of chorioamnionitis (aOR 2.70, 95% CI 1.22-2.36) and shoulder dystocia (aOR 2.37, 95% CI 1.33-4.25). However, there were no differences in the serious sequelae associated with these outcomes, including neonatal sepsis or Erb's palsy. CONCLUSION: Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate. LEVEL OF EVIDENCE: II.

 

Gail's comments

Good midwifery care and attending to the 3-Principles can protect the mother during a long labor. Sometimes labor is long when baby is stuck. Use the techniques to balance the body, bring in a body worker who can do myofascial release, a Chiropractor who can do adjustments, and/or a Craniosacral therapist; all help resolve the imbalance.

Caughey found that 1/3 of mothers after an active phase arrest were able to continue to a vaginal birth. That's way too small a number!  Active phase arrest means that the mother is 4 cm or more dilated when contractions are strong but no progress is being made. 

The clock is ticking and the OR is just down the hall. The culture of institutionalized birth will use technology whereas the homebirth midwife uses more wit and wisdom.  That's not to say that some of these cesareans aren't warranted. Some are.

Homebirth  moms with posterior or asynclitic babies often have active phase arrests. It is quite unusual to go on to a cesarean. Going in to the hospital for more support (some cultural, in other words the mom or midwife feels the need for those nurturing arms of Labor and Delivery, and sometimes IV Pitocin) The CPM2000study of 1500 planned homebirths showed an overall transport rate of 13% so many long labors finished at home with out significant issues.



 

 

On long labors

Good hydration with electrolyte drinks is important, but not overdoing it. Let the mother eat throughout labor. Help her to rest when contractions stall, and I mean snore. But without drugs. You'll gain skills to help her get that relaxed even if her emotional state is keyed up, believe me.A midwife or nurse can see that the mother isn't clinically exhausted. Many women are strong enough, when well nourished and supported to go through a long labor. 

But there is a time to call it quits. When baby is in a good position and labor is quite strong (advanced), we expect some descent within 4 hours of strong contractions. If baby has to rotate, or we have to get contractions in a regular pattern, then going 4 days is certainly an option. There are too many variables for you to think that you can get all you need for a safe birth from a web site, even mine! Please hire an experienced midwife or physician to help you assess labor to see if mother and baby are safe and fine to continue laboring.

 

Donate


Spinning Babies is facing an immediate "migration," new software installation for the behind the scenes portion of the website at cost of $680. This massive update is crucial for security and functionality. Alternatively, I could take the 100+ pages down and restart the site with new software at a lower cost, but much less content. Would you be ok with a 10 page site carrying only an outline of information? That's about how many other websites treat their content.

 Are you a woman or a loved one of a woman helped to avoid a cesarean by Spinning Babies Website? Has Spinning Babies helped you serve birthing families with techniques for labor progress? Do you have a little time to help Spinning Babies in return? If the migration costs $680 and 100 of my loyal users gave $68 dollars each, we'd get it covered. 

Did you know that Spinning Babies was hacked a few summers ago and had to go off line while I found hosting with security? Security is a real issue on the internet. 

Several years ago a grandmother donated $150 after a visit to Spinning Babies Website helped her daughter avoid a cesarean. Once a woman sent $50 because exercises on Spinning Babies stopped her hip pain and she was able to sleep well for the first time during the end of her pregnancy. Today, just a few dollars a year come through donations. Ever since the booklet went on sale donations dropped off. Could it be that people think sales income is significant to carry the website? I wish it were so, and do hope to boost the store soon.

Right now Spinning Babies is in need and so I'm asking those of you among my 4000 daily visitors to give something back. "Wait, Seriously?" you ask, "4000 people a day and only a few small donations a year!?" Yep, that's true.  If 100 of you, 1/40th of one day's visitors, gave $6.80, or about 5 British Pounds (or, 68 people giving 10.00 each) we could get this job done and secure the website. 

ICould it be that Spinning Babies has become such a part of the childbirth education scene that its taken for granted? Spinning Babies doesn't get grants. Spinning Babies isn't a nonprofit (But my husband will be surprised to hear that.)  I love giving this information as a gift to the birthing world, I'm rather delighted to help a woman understand she doesn't have to accept a cesarean before labor just because her baby is posterior! Or, help a woman flip her breechling head down. But with the cost of web maintainance increasing, I have to rethink how I might support my work.  

If you aren't able to give such a chunk of change, can you send your sympathy for $5? Or, are you a loyal Spinning Babies user who gives their undying support for $100? 

What ever you can send now will be seen as a huge message of support to keep Spinning Babies safe and online. Protecting one woman's birth just takes 4 minutes.

How are we doing? First day, 6 donations: $80 was given, Second day,  2 donations: $20.   Third day 3 donations: $70.  We can do it! Can we do it in a week??

 


 

Main Menu

Vic Froehlich quote

Evidence Base

I know from my experience that what everybody knew was not solving the problem. All they knew is what they learned in school. 

They don't know how to solve the problem, they know a procedure.  

We had to make up new stuff. 

And the evidence for that is that the problem got solved. 

Vic Froehlich

Super-Computer Engineer and Programmer and my husband

 

Bring it home