Remedy for an Intact Belly, Tincture of Time

130,000 unnecessary cesareans are done per year in the U.S. because doctors have been trained to fear a resting phase in active birth.

This is the news report about Dr. Caughey’s study:

While ACOG already recommends waiting at least two hours with adequate contractions in the setting of no progress in active labor, it is routine practice in many clinical settings to proceed with a cesarean for “lack of progress” before those ACOG criteria have been met, according to Aaron Caughey, MD, PhD, an associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, and senior author on the paper.

“One third of all first-time cesareans are performed due to active-phase arrest during labor, which contributes to approximately 400,000 surgical births per year,” said Caughey, who is affiliated with the UCSF National Center of Excellence in Women’s Health. “In our study, we found that just by being patient, one third of those women could have avoided the more dangerous and costly surgical approach.”

The cesarean delivery rate reached an all-time high in 2006 of 31.1 percent of all deliveries, according to the UCSF study. Arrest in the active phase of labor has been previously shown to raise the risk of cesarean delivery between four- and six-fold.

“Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection,” Caughey said. “After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture.”

The ten-year study identified all women who experienced what is known as active-phase arrest during their delivery at UCSF from 1991 to 2001. The study only included women with live, singleton deliveries who were delivered full-term.

The researchers examined maternal outcomes such as maternal infection, endomyometritis, postpartum hemorrhage and the need for blood transfusions. It also examined the infant’s Apgar score, rates of infection and frequency of admission to the neonatal intensive care unit, among other health indicators.

The study found an increased risk of maternal health complications in the group that underwent cesarean deliveries, including postpartum hemorrhage, severe postpartum hemorrhage and infections such as chorioamnionitis and endomyometritis, but found no significant difference in the health outcomes of the infants.

It concluded that efforts to continue with a normal delivery can reduce the maternal risks associated with cesarean delivery, without a significant difference in the health risk to the infant.

“Given the extensive data on the risk of cesarean deliveries, both during the procedure and for later births, prevention of the first cesarean delivery should be given high priority,” Caughey said.

Source: University of California – San Francisco

7 thoughts on “Remedy for an Intact Belly, Tincture of Time

  1. I’m interested in the language he uses. I wholeheartedly welcome and support the findings, and the fellow himself seems to be nicely reasoned etc, and gently encouraging of a change in mindset of the medicos.

    However he models a woman ‘asking’ whether she would be ‘given or allowed’ another 2 hours. Why does she have to ask anyone for some time? After all the hours she has been pregnant under her own power. It demonstrates where the power balance lies in a hospital ‘management’ of labour.

  2. I also noticed the language he used with regards to the maternal mortality rate with regards to c-sections: “it ‘seems'” to be higher. Is he trying to ensure he doesn’t get in trouble with his peers, or to avoid scaring women?

  3. Egads! He also states that only 40% of women in his facility go into labour spontaneously…60% are induced. While he has an important message, that of employing patience in the labour process, it’s too bad we couldn’t have this message accepted when it comes out of the mouths of lay midwives and mothers, who’ve employed such practices for so many years.

  4. Djeezz… they finally wake up… what a discovery, ha!

    When do they learn that men are not the ones who are supposed to interfere in childbirth. That would be a wonderful second ‘discovery’ for them to explore..

    Why don’t I like these kind of men….?

    Shaking head,

  5. Gee, what a fantastic “discovery”!!! Ok, so while nothing he said was news to me, I think that in order for there to be any change in the medical model of care, to which most birthing women are subjected in this country, there have to be MDs like this guy who will do the studies and convince the medical community of what has been known all along. Sad that it has to be that way, but I don’t think most OBs are going to listen to midwives due to the animosity in most cases.

  6. I agree with everyone’s comments. I don’t give a darn who gets the message out there that births that don’t proceed on a graph paper are not pathological. All that interests me is that fewer babies will be stressed with pitocin drips and fewer women will have major abdominal surgery.

    Maybe this obstetrician will “discover” someday that just giving women another two weeks of pregnancy beyond the due date will drop the cesarean rate ever further. One can only pray.

  7. yes I also thought it was interesting that he gives a little lesson near the end about how women could speak to their doctors without seeming too aggressive or confrontational. jayz. if women could just learn to speak up for themselves when their instincts are shouting at them “DANGER DANGER” we would have a lot smaller cesarean rate.

    it’s really not the doctors who are going to radically change the way obstetrics is practiced. if we waited for them it would take three hundred years for them to undo the harm done in the first half of the 20th century! what we really need is women who know that it’s OK for them to be aggressive when it comes to standing up for their bodies and their children! holy crap! if there’s one thing it’s definitely OK to be aggressive and non compromising about it’s the life and health of your own child!

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