My friend had a section 2.5 years ago because the hospital limit was 2 hours pushing. The nurse had topped up her epidural 3 minutes before she was fully dilated because she "couldn't possibly be ready to push yet!" (they didn't check first). Her daughter's head was VISIBLE in the vagina when they decided to section and the baby is scarred for life from injuries caused by the forceps needed to prise her already moulded head back up out of the pelvic inlet. She was dx failure to progress and CPD (baby's head too big to fit). Nearly a month ago she had her 900gms heavier son via HBAC without any trouble. It took her nearly 3 hours to push him out, but they were both completely fine throughout.

Not all hospitals are like this, and even within hospitals, not all Obs subscribe to the time limits. I could cry at the number of birth stories i read with a woman being diagnosed failure to progress because "After 13 hours of labour i still wasn't dilated" - for a first time mother the first stage (so 4cm to 10cm dilation) can take 24 hours and still be completely NORMAL. For some reason what was once recognised to be a normal labour is a too-long one. By definition, if the average labour is x hours, most will NOT be that length. We are all familiar with the idea that only a small %age of babies come on their due date, which is derived from the average length of a gestation, but so many women are sectioned or cut because their labour wasn't "normal" enough. We are now in a situation where the book which was supposed to provide a general rule of thumb for inexperienced or busy practitioners has become a set of hoops to hop through, and the "failure" of a given cervix or or uterus or vagina to obey the rules set out by the book can carry heavy penalties not for the doctor but for the woman and the baby.

As for what is "normal"... Most hospitals will want to accelerate (by artificially breaking the waters or giving IV sintocin) a labour which is not progressing at at least 1cm every 2 hours after 24 hours, providing they have room in delivery for the mum (if they're full they may send you home repeatedly for up to 3 days provided your membranes are intact). Most hospitals will give antibiotics by IV once 18-24 hours have passed since the mebranes ruptured. Most hospitals forbid you to eat once you are 4cm dilated - this can mean you face a long long hungry labour getting weaker with every hour. There have been several studies on this and all have found that women self-regulate food during labour and it causes no difference in maternal or foetal outcomes to let them choose to eat if they wish. They starve you "in case" you need a general anaesthetic for surgery, which is far more likely to happen if you're exhausted from not eating. Most hospitals also have set rules about certain situations and outcomes for the baby.

When DD was born she had passed meconium before birth (probably because they told me to fight the pushing reflex for the entire second stage!) and was a bit clogged up and shocked when she finally shot out (i was never worried, i KNEW she was ok, but her apgars were 9 at 1 minute, 7 at 5 and 10 at 10). She had her nose and throat suctioned and was put on my naked chest with an oxygen tube flowing under her nose and a bunch of warm towels and blankets wrapped around us both. She was BFing within 40 minutes. I was told if she'd been born in hospital she'd have gone to SCBU for the night, had 2-hourly glucose blood tests, not been allowed to BF and not been allowed out of her incubator until she could maintain her own body heat. As a sensitive first-time mother holding her 2-hour old baby when i was told this, i can tell you how my heart pounded and my grip tightened - they would take my baby from me!? When she NEEDED me?!

The most important thing is the ask about all this. "What is your policy on xxx" and "What will happen if i don't consent to that?" are the questions to ask. Don't be defensive, smile, be interested but firm. LISTEN when they tell you their reasons (and don't accept "It's hospital policy" - ask how the policy came about and if necessary point out that their basis is now out of date). TALK about what you want and decide what you will compromise on and what not.

If you are feeling uncomfortable with the care offered it is FINE to go look for different care elsewhere - often when pregnant women argue we are made to feel like naughty girls questioning our caring parents, and not grown women making some of the most important decisions of our lives. Don't be bullied. Hold on to the fact that caring for YOU is THEIR job, it's your baby and your body, they should be able to reassure you and be honest about the care they can give. Resist the pressure to shut up, be a good girl and let them get on with their job, get the answers you need.

Bx