by Cassandra R. Elias
Women take longer to give birth today than women 50 years ago, according to an analysis of nearly 140,000 deliveries conducted by researchers at the National Institutes of Health.
First-time-moms in the early 2000s took 2.6 more hours to progress to full dilation when compared with those giving birth in the early 1960s. For moms who had previously given birth, this early stage of labor took two hours longer in recent years than for women in the 1960s.
How does this data affect you and your birth? It could mean your healthcare provider will wait longer before suggesting an intervention.
Comparing contemporary labor trends with labor 50 years ago, researchers sound several differences:
• Babies arrived earlier and were bigger: On average babies in the contemporary group were born five days earlier and tended to weigh more.
• Overall labor is longer: Labor averaged 2.6 hours more for first-time moms and two hours more for moms who already had given birth
• Active phase of labor occurs later: Women in the 50s gradually progress on a curve with a more rapid increase in dilation occurring from 5.5 centimeters on. The analysis of recent births suggests that labor doesn't accelerate until later, around 6.5 centimeters.
• Labor practices have changed: More mothers are induced or use epidurals. Both have been shown to be associated with longer labor.
• More babies were born via c-section: 12 percent of first-time-moms in labor gave birth by c-section compared to 3 percent in the 60s.
While modern moms might have many reasons why labor lasts longer, two known characteristics of moms today are known to lengthen labor. These are an increase in BMI and older maternal age.
"Older mothers tend to take longer to give birth than do younger mothers," said the study's lead author, S. Katherine Laughon, M.D., of the Epidemiology Branch of theEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
Taking these factors into control doesn't completely explain the difference in labor times between now and then. Among the changes in delivery practices the researchers discovered an increase in the use of epidural anesthesia, the injection of pain killers into the spinal fluid, to decrease labor pains.
For the contemporary group, epidural injections were used in more than half of recent deliveries, compared with 4 percent of deliveries in the 1960s. The study authors noted that epidural anesthesia is known to increase delivery time on average from 40 to 90 minutes, but said it doesn't account for the increased length of labor.
Other differences between the two groups reflect changes in later stage delivery practices. For example, in 1960s-era deliveries the use of episiotomy (surgical incision to enlarge the vaginal opening during delivery), and the use of forceps, surgical instruments used to extract the baby from the birth canal, was notably more common.
In current practices, doctors may intervene when labor fails to progress. This could happen if the dilation of the cervix slows or the active phase of labor stops for several hours, Dr. Laughon explained in NIH's press release issued March 30, 2012.
In these cases, intervention can include administering oxytocin or performing a cesarean delivery.
This study didn't examine all of the practice patterns such as how mothers in earlier studies could have been up and walking more than women do today, whose activity is limited once they've received an epidural.
Clinicians are using a definition of abnormal labor that is from 50 years ago. Today, women labor longer and begin active labor at a later point in dilation.