Does length of labour increase chance of uterine rupture?

[*star*]

Yeah, so basically the title of my thread! Does length of labour increase chance of uterine rupture?

My friend's ob has said he will limit how long she can be in labour for (I know this is "normal" for some obs). But is there actually any evidence that says a long labour results in more likelihood of rupture?

[*star*]

*BUMP*

[Heaven]

I'm not sure, I haven't seen any evidence but I wondered the same thing when the OB I saw at the hospital said that to me!! She said instead of letting labour go on too long she would use the drip to speed things up...umm...wtf?? That seems really stupid to me! Yes lets use something that will definitely increase the risk of rupture rather than let nature take it's course. So I decided I won't be having a bar of that I feel way more comfortable going longer naturally.

Well that's my rant, lol, sorry I can't help with any actual useful research! Hope someone can!

[Arimeh]

Not in all my reading, no.

Its more like the OB's don't want women to labour all the time, and most OB's have that time limit of 1cm per hour of labour - whether you are going for a VBAC or not.

[Arimeh]

What is with all these double posts!

[berrme]

My ob gave me the timeframe of 1cm per hour. When I questioned him further he said they would only be checking every 4 hours generally, and it would only be a problem if labour wasn't progressing at all. I think that they worry about the length of labour unnessessarily, I haven't read evidence that it is dangerous to labour longer. But lots of c/s are for 'failure to progress' so maybe they just figure that if the labour isn't progressing a second time they might as well get the baby out faster??

Anyway, I know people who have laboured for ages during their vbacs and no ruptures.

[Arimeh]

I just thought I would add that technically my labour was 13.5 hours - and I didn't dilate to 13.5cm's..

I wasn't under any pressure though, and I think thats what it should be like for any women in labour - VBAC or not. Just let us do our thing and stop worrying us with silly time frames!

[Traveller]

newest guidelines state 0.5cm an hour is a more reasonable rate of minimum progression in labour, although I'm not sure if this differs for VBAC's. A lot of OB's don't use the new guidelines though so it's a good thing to ask antenatally.

[*star*]

Thanks guys,

I know that personally it isn't going to be an issue for me - they have no time limits on progression, so that's nice.

I was just wondering for this friend whether there was something she could definitively point to that said either way when she's discussing with her ob.

Cheers!

[Fleur]

I have never heard that it does... the Dr I discussed it with at hospital said it was more that, if things hadn't progressed after a certain time, then obviously something was wrong.. that was more true in my case though because I had already had 2 VB's, one of which was 3 hours.
So they were'nt expecting a long labour in any case, IYKWIM. But she certainly didn't say anything about a higher risk of rupture, and I have heard of Obs who treat first time labours as exactly that, be they VBAC or not - and that makes sense to me.

Heaven that is just weird! (sorry - but what you said - why do something to increase the chance of rupture?!)

[Heaven]

Ok, I think I've found somewhere where the OB I saw may have got it from.

This is the Queensland Health document on VBAC recommendations (Thanks Audax).
On page 9 is says 'slow progress may indicate an increased risk of uterine rupture' but doesn't have a reference for this actual statement. Only a reference (ref 4 in the article) for all the recommendations about what to do if labour is 'too long'.

And then when I go to that reference it says:

There is no available evidence to guide clinical practice in terms of length of either first or second stages of labour. However, the working group recommends that in cases of prolonged first or second stage the threshold for resorting to repeat caesarean section should be lower than in women with an intact uterus

Soooooo basically they have no evidence and they're just assuming it's bad, awesome way to practice medicine!

[Arimeh]

Soooooo basically they have no evidence and they're just assuming it's bad, awesome way to practice medicine!

[Fleur]

Soooooo basically they have no evidence and they're just assuming it's bad, awesome way to practice medicine!

[gardeningkate]

I vba2c in 2009, I took on several doctors before finding a supportive midwife led program in a hospital. There is no evidence at all that I could find to support the assertion that long labours increase your chance of rupture. I posed the question to each doctor, is that your opinion, or is there actually medical evidence/statistics to support that assertion, to which I mostly got verbal and emotional abuse, however the ob in the hospital where I did birth smiled and said that I probably knew as well as he did that it was a difficult thing to prove.
Smiling and asking for supportive evidence, and asking why, for specific answers is empowering. Also, when you are given a sensational or general statistic it is important to ask for the specific parameters of the study. What are the dates that were used to compile them, have they given you a statistic for ruptures that include all types of uterine scars, or is it relevent to LUTS, double sutering, and the absence of inducing and augmenting drugs. All of these factors considerably reduce the incidence of rupture. It is also useful to ask obs what the medical definition of rupture is, the statistics given include any and all tears to that area, dehineneces (sorry, I can never remember that word) many of which are non medical events and have no impact on labour. The word rupture gives the impression that the whole thing rips open, but in most cases there may be small openings in a couple of parts of the scar, not necessarily going the whole way though all the layers of stomach muscle and uterine tissue. An ob who could not or would not answer these questions is on shaky ground as far as I was concerned, and I made sure they knew I felt that way. VBAC is not a big deal in many european countries, such as norway and sweden, even britain. And babies are not dying all over the place. In fact I think from memory they have much better results than we do.
Due to hospital policy I had to "limit" to 6 hours of labour, but it was up to me and my midwife to determine when labour had officially started. Unofficially it went for much longer than my allowable limit, it helped that I was mobile and upright the whole time, and had supportive people with me.
So, to cut a long story short, IT IS A SELF PERPETUATING MEDICAL MYTH WITH NO EVIDENCE. However I think many obs do actually believe it, same with big babies. Another myth, you should read Henci Goers book, obstetric myths, and another called "The silent Knife"
Makes for some very interesting reading!!

[JennaJayen]

Just thought I'd add this...

My friendhas never had a c-section, but was actually in full on labour (regular contractions, 10 minutes apart and all and it all started when she was 2cm dilated) with her DS for 2 weeks before she went to hospy.
Turned out the only reason her DS hadn't come before then was because her amniotic sac was bit thick so her waters had to be broken in hospy and her DS was born 4 hours later.

She later got told off by the OB on call for not coming in sooner (she'd spent the 2 weeks cleaning her house like a mad woman and hardly sleeping because she didn't know she was actually in labour lol).

Just thought I'd mention that to you all as something you can use to get at your OB's

[javic]

I am planning a VBAC also and read up a lot on this sort of thing at the beginning of my pregnancy (months ago).

I did read that the length of labour could increase the chance of rupture, and I vaguely recall that it was backed up by studies (but no idea where I read it sorry).

I think the basic idea was, that if there was absolutely no progress in labour, that it indicated some sort of problem. If there was a blockage, or if the baby was lying the wrong way and was having difficulty moving down at all, then the full pressure of the contractions would be fighting against a brick wall and that this pressure, with no give, would be what caused the increase chance of rupture. So, kind of like us running into a soft mattress, versus running into a brick wall. One equals ouchies, the other doesn't.

This might all just be theory, with no practical studies to back it up, I can't 100% recall. But it makes logical sense to me.

Thing is, if there is some progress, then the Dr should allow labour to continue. Where I plan to VBAC they also say 1cm every two hours, but only check every 4 or 8 hours - so no real hurry I gather.