The definition of a “normal” length of labor that is currently used by most healthcare providers is obsolete. . . . As long as mother and baby are both healthy, and as long as the length of labor does not qualify as an arrested labor, laboring women should be treated as if they are progressing normally. Women who are being medically induced should be given more time to complete the early phase of labor. . . . In the end, if more care providers begin using evidence-based definitions of labor arrest and failed induction, we will begin to see fewer of these diagnoses, and a simultaneous lowering of the Cesarean rate.From The Evidence for Doulas
When continuous labor support was provided by a doula, women experienced a 31% decrease in the use of Pitocin, a 28% decrease in the risk of C-section, a 12% increase in the likelihood of a spontaneous vaginal birth, a 9% decrease in the use of any medications for pain relief, a 14% decrease in the risk of newborns being admitted to a special care nursery, and a 34% decrease in the risk of being dissatisfied with the birth experience.From What is the Evidence for Induction or C-section for a Big Baby?
In summary, evidence does not support elective C-sections for all suspected big babies, especially among non-diabetic women. There have been no randomized, controlled trials testing this intervention. It is likely that for most non-diabetic women, the potential harms of an elective C-section for a big baby outweigh the potential benefits.From The Evidence for Skin-to-Skin Care after a Cesarean
In summary, the research we have so far demonstrates that “very early” skin-to-skin care after a Cesarean is safe and beneficial. More research is needed on “immediate” skin-to-skin care , or care that is initiated in the operating room. The low rates of skin-to-skin after Cesarean and reports from researchers suggest that women and care providers may face multiple barriers to skin-to-skin care after Cesareans.From What is the Evidence for Pushing Positions?
For women without an epidural, pushing in an upright position is associated with a decrease in the risk of episiotomies, vacuum and forceps-assisted deliveries, and fetal heart rate abnormalities, an increase in the risk of second-degree tears, and a possible increase in the risk of having blood loss more than 500 mL. Women with walking epidurals who push in upright positions may experience a shortened labor and pushing phase. More evidence is needed to evaluate pushing positions in women with traditional (non-walking) epidurals. The take home message is that women should push in any position they find comfortable– it is not necessary to be continuously upright or continuously lying down during the pushing phase.
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