A new study (read about it here) has found that giving women longer to labour can reduce c-section rates. When women were given an extra hour to push the c-section rate was cut roughly in half.

The study, which has just been published in the American Journal of Obstetrics & Gynaecology, was admittedly a small one, covering just 78 women. They were all delivering their first baby and were randomly assigned to have either the usual three hour time limit or given an extra hour to push (it only covered women who had epidurals as they didn’t end up with any patients who didn’t have one qualifying for the study).

The current accepted wisdom is that first-time mothers have three hours to push with an epidural and two without. After that they’re considered to be having a prolonged second stage of labour and it’s common for a c-section or assisted delivery (i.e. vacuum or forceps) to take place.
an extra hour of pushing may prevent a c section
The study found that 43.2% of the women who were given three hours to push had a c-section while just 19.5% of those who were given four hours had one. The researchers say this confirms what they’ve seen in practice for years – that there can be benefits to allowing women to labour longer. They were excited to see it reduced the number of c-sections in this group of women, calling the size of the reduction dramatic.

There was no evidence that giving the women more time to push put them or their babies at greater risk, although the study was too small to state that conclusively. Particularly as prior research has found there is a risk to both mother and child when labour goes on too long.

What I found fascinating is that those timing recommendations were developed in the 1800s and haven’t really been challenged since, which seems a bit mad, given how much medicine has advanced in that time. There has only been retrospective data used to validate those guidelines, including a study in the 1950s that found women who delivered within two hours had lower rates of infection and serious postpartum bleeding and another in 1955 that concluded most women without anaesthesia gave birth within two hours.

It’s thought that women today take longer to labour than they did 50 years ago and while it’s not known why that is, this could mean that birth care providers are performing c-sections too early in the process as they’re using an out-of-date measure.

While this study is unlikely to change recommendations any time soon, the researchers say women should talk to their care providers about their options and if the primary reason for a c-section is the length of time labour has gone they can always ask if they’re a candidate to try for a bit longer. But at the same time, they also need to understand there are times when medical intervention is necessary.

Anything to do with pushing gives me a slight shudder. Of my five hours in active labour, two of those were spent in this stage and it was the most exhausting thing I’ve ever done. As far as I remember it didn’t hurt, but it was immensely tiring. At one point my midwife got a doctor in to check on things and I found myself wishing he would say I needed a c-section, just so I could have a rest.

In hindsight I’m glad that didn’t happen as my recovery from labour was very straightforward. And looking back now, that time pushing was a small dot in the greater landscape of nine months of pregnancy. While it’s horrible when you’re doing it, if you can hang in there a bit longer and it’s safe to do so then it’s probably worthwhile (although if you end up still needing a c-section anyway, you’ll probably wish you didn’t… Why can’t they develop a crystal ball that predicts labour outcomes?!)

Tell us about your experience. How long did you push for?

