More evidence on how to keep birth normal

Another study has shown that the adoption of evidence-based approaches to determining the onset of active labour, assessing the progress of labour and determining whether a woman/baby are truly experiencing dystocia may safely decrease the use of oxytocin and the caesarean section rate (Neal et al 2018).

A group of researchers in the US analysed data from the experiences of more than 27,000 healthy women who had their first baby in a hospital. Here are some of the key results:

 

When they were admitted to the hospital, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45‐2.96).

Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor.

Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45‐3.73).

Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic.

Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. (Neal et al 2018)

 

These results further confirm that, when women are admitted to hospital later in labour, that is, once labour has become established, their chance of unnecessary intervention is lowered. Crucially, and despite those ranting to the contrary, it is entirely possible to take an approach that decreases intervention, including caesarean section, without reducing safety. In fact, there is plenty of evidence elsewhere to show that physiological approach is safer in many ways. The ‘solution’ to these findings isn’t straightforward, however. Proponents of the medical model of birth have spent decades convincing women that pregnancy and birth need to be monitored and managed, so it can be somewhat scary to suddenly be told ‘stay home by yourself; it’s better for you and the baby’. It’s a complex picture, and we need careful and creative solutions.

 

The Research

Background: The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women’s risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates.

Methods: A sample of low‐risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes.

Results: At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45‐2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45‐3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic.

Conclusions: Adoption of evidence‐based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.

 

Neal JL, Lowe NK, Caughey AB et al (2018). Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women. 2018 May 30. doi: 10.1111/birt.12358. [Epub ahead of print]
Photo by Ashley Batz on Unsplash

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