EurekAlert reports on a trial finding that giving 1st-time mothers more time to push out their babies cuts the cesarean rate for prolonged second stage in half. The American College of Obstetricians & Gynecologists’ sets the threshold for prolonged second stage in women with epidurals at 3 hours. Seventy-eight 1st-time mothers with epidurals who had exceeded this threshold were randomly allocated either to standard management, which was “expedited delivery” via cesarean or instrumental vaginal delivery, or to a minimum of one additional hour to labor. The cesarean rate in women given at least one more hour was 20% (8/41) vs. 43% (16/37) in the standard management group. No differences were found in maternal or neonatal outcomes, although the study was too small to detect small, but clinically important, differences. Of course, the reduction in cesareans was a very large, clinically important difference.
The Take-Away: Women can feel confident in refusing vaginal instrumental or cesarean delivery when the only indication for it is that they have exceeded a preset time limit.