Many women who have given birth say that labor seemed to last forever – and perhaps that’s because today’s pregnant women are spending more time in the delivery room than women 50 years ago did.
A new study published in the American Journal of Obstetrics and Gynecology compared the childbirth and delivery data of roughly 140,000 births from 1959 to 1966 and 2002 to 2008.
The researchers from the National Institutes of Health (NIH) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development found that today’s first-time mothers spend about 2.6 more hours in the first stage of labor – the time it takes for the cervix to completely dilate to 10cm. For women who have already had children, labor now takes about 2 additional hours compared to the 1960s.
A number of factors were identified as potentially contributing to the increase in labor duration. Modern mothers are about 4 years older than their 1960s counterparts, and older mothers tend to take longer to give birth. The use of epidural anesthesia (a painkiller injection into the spinal fluid to decrease pain), a procedure known to increase delivery time, has also increased from 4% to more than 50%. And “facilitating” procedures such as episiotomies (surgical incisions to enlarge the vaginal opening) and forceps delivery, which used to be routine decades ago, are much less common today.
Labor induction (stimulation of uterine contractions) also saw a more than twofold increase from 9.5% to 22.5% of deliveries in 1990 to 2006. Induction may take place when cervical dilation slows or when the active phase of labor (when contractions become longer, stronger, and closer together in preparation for the “pushing” phase) comes to a stop. Doctors can induce by administering a hormone called oxytocin, which speeds up labor when contractions slow down, and it was administered in 31% of deliveries in 2002-2008 versus 12% of deliveries in the 1960s. Without it, labor might last even longer, said lead researcher Katherine Laughton.
Researchers suggest the increased rate of induction may be linked to increasingly frequent pregnancy complications such as gestational diabetes (pregnancy-induced diabetes) and preeclampsia (pregnancy-induced high blood pressure); these complications are thought to be the result of rising maternal age and body mass indices (BMI) in today’s mothers.
High blood pressure was the most common variable for preterm (24-36 weeks) induction of labor in modern women, with 42.6% of first-time mothers and 31.6% of multiple-child mothers being induced. It was followed by fetal (28.7% and 27.3%) and maternal conditions (24.7% and 27.1%).
When induction is unsuccessful, another form of doctor intervention may be to perform a cesarean delivery, a procedure whose frequency has risen 400% since the 1960s from 3% to 12% due to both necessity and choice. First-time mothers in the 2000s who have been induced have the lowest vaginal delivery rates, with 62.8% preterm and 63.7% at term, so many often deliver via cesarean section.
While the study does not distinguish every factor for longer labor and delivery times, Laughton stresses that it does reflect the need to reexamine current delivery practices. She suggests that by waiting longer for labor to progress into the active phase and by choosing induction candidates more carefully based on their health and cervical readiness, the national cesarean delivery rate can be reduced.
The Bottom Line
For many women, childbirth can be one of the, if not the, most rewarding experiences in their lives. But in its joy, it’s easy to forget that it is also a process that places an immense amount of stress on the body and requires a long period of rest and healing.
A very important fact brought up by the researchers is that many pregnant women today weigh more, with an average BMI of 24.9 versus 23 for women five decades ago. Though 24.9 falls right at the cusp of normal as defined by the CDC, it is dangerously close to overweight; and according to a new study that suggests current BMI calculations actually underestimates body fat, 24.9 likely falls within the overweight category.
Overweight women face an increased risk of diabetes and hypertension (high blood pressure), and whether this is a preexisting condition or brought on as a result of pregnancy, the study indicates women with these conditions are at risk for complications and, correspondingly, preterm induction of labor. And the study shows that about a quarter of all first-time mothers who induce end up having to deliver via cesarean regardless of whether induction was elective or due to extended labor duration.
No matter how you look at it, a cesarean section is a major surgical procedure, often performed under general anesthesia, which carries its own inherent risks. It requires a longer recovery period than vaginal birth, and according to the NIH, the incision may leave a weak spot in the wall of the uterus, which could cause problems with vaginal birth in the future.
While there are no definite ways to make pregnancy and childbirth easy, this information reminds us that it makes sense to be in optimum health to minimize any complications that may arise. When bringing a new life into the world, don’t we want to be able to give them 100%?
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.