Childbirth is a unique journey, filled with anticipation, excitement, and sometimes, a bit of uncertainty. Understanding the stages of labor and how they’re managed can help you avoiding a C-Section. In this blog post, we’ll explore the guidelines outlined by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) in their 2014 Obstetric Care Consensus Statement titled “Safe Prevention of the Primary Cesarean.”. Equipped with the knowledge about these Guidelines and mentioning them to your care team will increase your chances of having a vaginal birth.
First Stage of Labor: The Start of Your Journey
The first stage of labor begins with the onset of regular contractions and ends when your cervix is fully dilated. This stage is further divided into the latent phase and the active phase. Here are some key recommendations from ACOG and SMFM for this stage:
Prolonged latent phase: If your latent phase lasts more than 20 hours as a first-time mother (nullipara) or 14 hours if you’ve given birth before (multipara), this shouldn’t be a reason for a C-Section. Even if the latent phase is longer than these times, it doesn’t necessarily indicate a problem that requires a C-section.
Slow but progressive labor: If your labor is progressing slowly but steadily, this is also not a reason for a C-Section. The key here is that progress is being made, even if it’s slower than average.
Active labor progress standards: The standards for active labor progress shouldn’t be applied to you before you reach 6 cm dilation. This means that the expectations for how quickly labor should progress should be adjusted for this stage.
Cesarean delivery for active phase arrest: If you’re considered for a C-Section due to active phase arrest (when labor progress stops during the active phase), you should be at or beyond 6 cm dilation with ruptured membranes, and either:
- Have had 4 hours of adequate contractions without any change in cervical dilation, or
- Have had at least 6 hours of oxytocin (a drug used to induce or augment labor) with inadequate contractions and no change in cervical dilation.
Second Stage of Labor: The Final Stretch
The second stage of labor begins when your cervix is fully dilated and ends with the delivery of your baby. Here are the ACOG and SMFM recommendations for this stage:
Maximum length of the second stage: There is no absolute maximum length of time set for the second stage of labor. The duration can vary widely among individuals.
Diagnosis of labor arrest in the second stage: The diagnosis of labor arrest in the second stage shouldn’t be made until you’ve been pushing for at least 2 hours if you’ve given birth before, and at least 3 hours if you’re a first-time mother. Longer durations may be appropriate for you on an individual basis, for example, with epidural anesthesia or fetal malposition, as long as progress is documented.
Operative vaginal delivery: Operative vaginal delivery, which involves the use of special instruments like forceps or a vacuum device to help deliver your baby, is considered a safe and reasonable alternative to C-Section.
Manual rotation of the fetal occiput: If your baby is malpositioned in the second stage of labor, manual rotation of the fetal occiput is a reasonable intervention to consider before resorting to operative vaginal delivery or C-Section. Furthermore, assessing your baby’s position in the second stage of labor is essential, especially when abnormal descent(your baby not moving down into the birth canal as expected) is noted.
The Goal: Safely Avoid a C-Section
These recommendations aim to safely prevent unnecessary primary cesarean deliveries. A cesarean delivery is a major surgical procedure and carries risks, so it’s important to ensure it’s only performed when medically necessary.
The ACOG and SMFM guidelines emphasize patience and individualized care during labor. They remind us that labor progression can vary widely among individuals and that a slower labor does not necessarily indicate a problem.
Understanding these guidelines can help you and your healthcare provider make informed decisions about labor management. Leading to less C-Sections in general. It’s a reminder that every birth is unique, and the approach to each should be tailored to the individual’s circumstances and needs.
In conclusion, the journey of childbirth is a delicate dance between nature and medical intervention. The ACOG and SMFM guidelines provide a roadmap for navigating this journey, promoting the safest outcomes for both you and your baby. Remember, the ultimate goal is a healthy mother and a healthy baby, and these recommendations are designed to support that outcome.
We hope this blog post has provided valuable insights into the recommendations for the first and second stages of labor. As always, it’s important to discuss these guidelines and any questions or concerns you may have with your healthcare provider. They are your best resource for understanding how these recommendations apply to your unique situation.
Olivia S
As an experienced writer and mother, I've discovered my true passion lies in the world of parenting. I understand firsthand the challenges and joys of raising children, and I'm committed to sharing my experiences and insights with other parents. With my degree in English and years of experience as a freelance writer, I've developed my unique writing voice that resonates with my readers. My approach to writing is warm and compassionate, and I aim to provide practical advice and support to parents navigating the ups and downs of parenthood. Whether I'm sharing tips on sleep training or exploring the latest trends in children's education, I write from the heart and strive to create informative and engaging content.