A recent study released by the National Institutes of Health (NIH) shows that, for a variety of reasons known and unknown, women take longer to deliver babies today than they did in the 1960s. So, ladies, you may want to ignore what your mothers and grandmother say about how long they were in labor–although it may seem like they are embellishing, labor really was a lot faster for them.
The study, which compared data from deliveries from the early 1960s and from the early 2000s, found that the first stage of labor (before active pushing begins) lasted 2.6 hours longer for first-time mothers in the latter group. Data from around 40,000 deliveries between 1959 and 1966 and 100,000 deliveries between 2002 and 2008 were compared. All of these deliveries studied were spontaneous, meaning not induced, according to a recent Reuters article.
Some of the differences for the variation in the labor times are unknown. However, some of the practices routinely used in the 60s are much less common today, such as the use of episiotomies and the use of forceps to extract the baby. Such practices, quite obviously, speed things along quite a bit. While other practices like the administration of epidural anesthesia are much more common today (more than 50 percent use epidurals now, compared to only 4 percent in the 60s). The use of epidurals, which inject pain killers into the spinal fluid, is known to increase delivery times while decreasing paid associated with it.
Doctors are much more quick to administer the hormone oxytocin, which is given to speed up labor when if fails to progress, in the 2000s than they were in the 60s. [In only 12 percent of deliveries in the 1960s was oxytocin used, compared to 31 percent now.] Dr. S. Katherine Laughon, M.D., of the Epidemiology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the lead author of the study, warned that “[w]ithout [oxytocin], labor might even be longer in current obstetrics than what [they] found.”
Further, in current practice, more doctors may resort to a cesarean (C-section) delivery if labor fails to progress–when the dilation of the cervix slows or the active labor phase stalls for several hours. Only three percent of first timers had C-sections in the 1960s, compared to 12 percent in the 2000s.
Other factors might play a part in the lengthier labor times. Women giving birth are older, by an average of four years, than they were in the 1960s. According to Dr. Laughon, “[o]lder mother tend to take longer to give birth than do younger mothers.” Women have a higher body mass index (24.9 now compared to 23 in the 1960s). Babies are also born an average of five days earlier and weigh more. Although the increased use of oxytocin and C-sections should show shorter labor times, that is not the case. This means that there are probably other factors contributing to lengthier labors as well.
According to an article appearing in The Washington Times, medical professionals rely on the duration of “normal” labor to decide when it is time to speed things up or to intervene with a C-section. The results of this study seem to suggest that there is a new “normal.” Dr. Laughon urges that “we need to revisit the definitions of ‘abnormal’ labor, and the timing of the interventions that we use.”
The use of C-sections, which pose a much greater risk to mothers and to babies than natural deliveries, is also of concern. According to Dr. Laughon’s co-author, Dr. D. Ware Branch of Intermountain Healthcare and University of Utah, professionals use the guidelines about labor duration “to draw the line in the course of a labor as to when it’s time to intervene with a Cesarean” and, based on the study’s findings, “that certainly calls for a reassessment of when one should draw the line.” Both Drs. Laughon and Ware Branch agreed with the conclusion drawn in a National Public Radio (NPR) article, that “they’re using an out-of-date yardstick for how long a ‘normal’ labor should take.”
A recent two-part series addressed the Obama Administration’s Strong Start initiative, which was aimed at reducing the number of pre-term births in high-risk Medicaid recipients and to advocate the reduction of the number of early elective deliveries. Those issues, along with the increased labor times addressed in the study, appear to show that what was considered “normal” should be adjusted to account for the “new normal” and that the guidelines regarding delivery should be updated.