02 April 2012

Childbirth takes longer now than 50 years ago

Many tasks can be tackled more quickly now than 50 years ago, but delivering a baby is not one of them, a new US government study finds.


Many tasks can be tackled more quickly now than 50 years ago, but delivering a baby is not one of them, a new US government study finds.

Compared with the 1960s, US women have in recent years spent two to three hours longer in labour, according to researchers at the US National Institutes of Health.

The extra time is spent in the first stage of labour – the longest part of the labour process, before the "pushing" stage. New moms, themselves, are different now than 50 years ago; on average, they're older and weigh more, and their newborns are bigger too.

"But even when we take these changing demographics into account, labour is still longer," lead researcher Dr Katherine Laughon, of the National Institute of Child Health and Human Development, said.

"We weren't able to fully address the potential reasons with this study," Laughon said.

One partial explanation may be epidural pain relief, which is far more common now than 50 years ago. Epidurals are known to slow labour down by about 40 to 90 minutes, Laughon said. And many women may gladly trade the extra time in labour for the pain relief.

What’s normal?

From there, the explanations get more speculative.

Laughon noted that many more women now have labour inductions or planned caesarean sections versus decades ago. So women who actually go into spontaneous labour these days may differ somehow from their counterparts of 50 years ago.

But whatever the underlying reasons, Laughon said the findings suggest that doctors may need to rethink the definition of "normal" labour – a concept that's based on what was the norm for women a half-century ago.

For example, doctors have traditionally considered labour to be abnormal if there's no change in the cervix after two hours in the "active" part of the first stage of labour.

At that point, they may intervene by either giving the medication oxytocin, which stimulates contractions, or doing a C-section. But based on these new findings, doctors may be able to wait longer before taking those measures - "as long as the mom and baby are healthy," Laughon said.

Epidurals much more likely

The findings, reported online in the American Journal of Obstetrics & Gynecology, are based on two government studies done decades apart.

One included about 39 500 US women who delivered a full-term "singleton" between 1959 and 1966. The other tracked more than 98,000 women who had a full-term singleton between 2002 and 2008.

All of the women had a spontaneous labour – that is, no labour induction.

Not surprisingly, contemporary women were far more likely to get an epidural – 55% did, versus just 4% of their counterparts 50 years ago. And their doctors were much more likely to end up doing a caesarean to deliver the baby, or to use oxytocin.

Twelve percent of women in the recent study had a C-section, compared with 3% in the 1960s. Meanwhile, 31% were given oxytocin, versus 12% 50 years ago.

When it came to length of labour, first-time moms in recent years typically spent 2.6 hours longer in the first stage, compared with their counterparts in the 1960s. The difference between generations was a bit smaller – two hours – when the researchers focused on women who'd given birth before.

Though the reasons for the longer labour times are not fully clear, Laughon said the bottom line is that there may be a new "normal." "I think we need to revisit the definitions of 'abnormal' labour, and the timing of the interventions that we use," she said.

(Reuters Health, Amy Norton, March 2012) 

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