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Long Labor Does Not Worsen Outcomes for Babies

We all know that every labor is different and the time it takes can range from a few hours to a few days. The most marked difference is between women who have already had a vaginal birth, and women who are laboring for the first time. However, even among first time moms, there is a wide range of normal labor. Some first labors are fast and efficient, culminating with a baby in your arms only six or eight hours after the initiation of strong contractions. Others are more gradual, with over 30 hours of intense contractions before you finally meet your baby.  Recently, new evidence was published which reassures us that intervention to speed up labor may not be necessary, as long as there is some continued progress and no signs that the mom or baby are distressed. A new study shows that while these prolonged labors may have a higher rate of cesarean section or maternal infection, the babies are not bothered by it at all.  
Physicians and researchers at the University of California at San Francisco undertook an eighteen year study looking at the maternal and neonatal outcomes of prolonged labors. They collected data from over 10,000 women’s first labors. In their study, the median length (or 50th percentile) of first stage of labor was 10.5 hours, and ranged from 2.8 hours to 30 hours.

The researchers found that women with a first stage of labor lasting longer than 30 hours had a 13.5% risk of having a cesarean section, versus 6.1% in women with labors lasting 30 hours or less. They also found an increase in chorioamnionitis, or maternal infection, (23.5% compared with 12.5% in shorter labors).

"It is important to note”, the authors say, "that although a prolonged first stage is associated with a higher risk of cesarean delivery, the majority of women still achieved vaginal delivery, even in those with a first stage of labor lasting beyond 30 hours." And they add, that "the presence of chorioamnionitis may have caused dysfunctional contractions, which led to longer labor,” rather than the longer labor causing the infection.

Despite the slight increased caesarian section rate or maternal infection rate, the study found no associated adverse outcomes for the newborns. The only significant finding was an increase in newborn admission to the neonatal intensive care unit, but the authors feel this is likely due to work-ups necessary in the presence of chorioamnionitis, and not related the baby actually being sick or needing treatment. 

The authors conclude that "management of labor should involve a thorough consideration of the ongoing risks of continued expectant management compared with the risks of intervention on the current and future pregnancies as well as the incorporation of patient preferences into the decision-making process." 
In other words, labor is complex and individual, and arbitrary time limits are not evidence-based. If mom and baby are both fine and there is some continued labor progress, you don’t necessarily need pitocin just to speed up a slow labor! 

Written by Leila Forman, CNM