Giving women more time to labour has reduced the need for c-section by more than half, according to a new study.

Researchers at Thomas Jefferson University found women who were fully dilated in the second stage and had an epidural could deliver safely after four hours, rather than the previously recommended three hours.

From the late 1800s, the standard recommendation has been to allow women to remain in the second stage of labour fully dilated for two hours before performing a c-section. One hundred years later, the recommendations were updated to give women with an epidural in place an extra hour to labour in second stage before a c-section was performed. Women without epidurals in place are still only given two hours before a c-section is performed for arrested labour.

While small, the new study is the first of its kind, and looked at what happens when women with epidurals in the second stage of labour are given four hours, instead of three. The researchers recruited 78 women who were between 36 weeks and 42 weeks pregnant. They were to be given epidurals during labour and randomly assigned to either the standard recommendation of three hours or four hours during second stage.

Longer Labour Reduces C-Sections By 55%

From the group of women given three hours, almost 45% had c-sections, compared to 19.5% in the four hour group. Not only did the incidence of c-section birth drop by 55%, the researchers noted there were no associated negative health consequences to mothers or babies.

C-section rates are climbing every year. In the US, one in three babies are born via c-section, and the rate of scheduled c-sections for non-medical reasons is rising. Australia is very closely behind. This is despite the World Health Organization recommending rates of c-sections should be no higher than 10-15%.

C-section surgery poses significant risks to both mothers and their babies. Women who have a c-section face a number of serious complications following the surgery as well as places risk on future pregnancies. The health of babies born via c-section is impacted, increasing the chances of respiratory distress, costly stays in neointensive units, as well as a higher risk of dying after birth compared to babies born vaginally.

How To Prepare For Second Stage

When the second stage of labour begins, contractions are no longer opening the cervix as it is fully dilated. Your uterus begins a series of strong, expulsive contractions which are often described as involuntary and powerful.

The muscles at the top of your uterus are pressing down on your baby’s bottom, pushing the baby downward through the opened cervix and into the birth canal. Find whatever position feels best for you to push. Many women instinctively choose upright positions where they are able to push against something: hands and knees, kneeling into their partner’s lap, over the edge of a table or bed, even squatting (although this position takes some practice).

If you are very tired or have an epidural in place, you can lie on your left side with your partner or doula holding your leg up. Avoid lying on your back or being propped up in a semi sitting position. This closes the pelvic outlet by up to 30% and doesn’t allow room for your baby to rotate and move down, which can prolong labour.

Women are often under the impression they have actively push with each contraction. This might feel right for you, but it isn’t necessary. Your uterus will provide the muscle to push out the baby, and if you avoid tensing your body and breathe downward with each contraction, you are providing much needed oxygen to your muscles and your baby. Making a low ‘oh’ or ‘ah’ sound as you breathe out can keep your jaw and neck muscles relaxed, which helps keep your pelvic floor relaxed as well. It is a good idea to practice this breathing technique daily during pregnancy.

How To Avoid A C-section

Choosing your birth care provider is critical to reducing your chances of a c-section. There are doctors and midwives who value labour as a natural process and will support you to achieve a normal birth. Discuss with your care provider what their approach is with regard to the second stage of labour and find out what sort of time restrictions they have.

During second stage, the midwives will check your baby’s heart rate after each contraction. This is to ensure your baby is coping with the strong contractions which reduce the placental flow for a few seconds. Unless your baby is distressed there may be more chance of allowing this stage of labour to go longer if you are also coping. Discuss the possibility of waiting longer with your care provider during pregnancy to ensure you have the best chance of avoiding a c-section.

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Avoiding the risks of c-section surgery is usually possible with good support and making informed decisions about your care. Women who are able to labour for longer with positive support from their birth team will reduce their risk of c-section and avoid complications for future pregnancies.

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