Researcher Aaron Caughey finds giving more time will reduce 400,000 cesareans a year. See the Nov. 18, 2008 article called Patience after stall in labor advised. Read the research itself. Obstetrics and Gynecology 2008; 112: 1109-15 Perinatal Outcomes in the setting of active phase arrest in labor.


From the abstract at PubMed:

We identified 1,014 women with active phase arrest: 33% (335) went on to deliver vaginally, and the rest had cesarean deliveries. Cesarean delivery was associated with an increased risk of chorioamnionitis (adjusted odds ratio [aOR] 3.37, 95% confidence interval [CI] 2.21-5.15), endomyometritis (aOR 48.41, 95% CI 6.61-354), postpartum hemorrhage (aOR 5.18, 95% CI 3.42-7.85), and severe postpartum hemorrhage (aOR 14.97, 95% CI 1.77-126). There were no differences in adverse neonatal outcomes. Among women who delivered vaginally, women with active phase arrest had significantly increased odds of chorioamnionitis (aOR 2.70, 95% CI 1.22-2.36) and shoulder dystocia (aOR 2.37, 95% CI 1.33-4.25). However, there were no differences in the serious sequelae associated with these outcomes, including neonatal sepsis or Erb's palsy. CONCLUSION: Efforts to achieve vaginal delivery in the setting of active phase arrest may reduce the maternal risks associated with cesarean delivery without additional risk to the neonate. LEVEL OF EVIDENCE: II.


Gail's comments

Good midwifery care and attending to the 3-Principles can protect the mother during a long labor. Sometimes labor is long when baby is stuck. Use the techniques to balance the body, bring in a body worker who can do myofascial release, a Chiropractor who can do adjustments, and/or a Craniosacral therapist; all help resolve the imbalance.

Caughey found that 1/3 of mothers after an active phase arrest were able to continue to a vaginal birth. That's way too small a number!  Active phase arrest means that the mother is 4 cm or more dilated when contractions are strong but no progress is being made. 

The clock is ticking and the OR is just down the hall. The culture of institutionalized birth will use technology whereas the homebirth midwife uses more wit and wisdom.  That's not to say that some of these cesareans aren't warranted. Some are.

Homebirth  moms with posterior or asynclitic babies often have active phase arrests. It is quite unusual to go on to a cesarean. Going in to the hospital for more support (some cultural, in other words the mom or midwife feels the need for those nurturing arms of Labor and Delivery, and sometimes IV Pitocin) The CPM2000study of 1500 planned homebirths showed an overall transport rate of 13% so many long labors finished at home with out significant issues.



On long labors

Good hydration with electrolyte drinks is important, but not overdoing it. Let the mother eat throughout labor. Help her to rest when contractions stall, and I mean snore. But without drugs. You'll gain skills to help her get that relaxed even if her emotional state is keyed up, believe me.A midwife or nurse can see that the mother isn't clinically exhausted. Many women are strong enough, when well nourished and supported to go through a long labor. 

But there is a time to call it quits. When baby is in a good position and labor is quite strong (advanced), we expect some descent within 4 hours of strong contractions. If baby has to rotate, or we have to get contractions in a regular pattern, then going 4 days is certainly an option. There are too many variables for you to think that you can get all you need for a safe birth from a web site, even mine! Please hire an experienced midwife or physician to help you assess labor to see if mother and baby are safe and fine to continue laboring.


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Hi Gail, 

I want to say thank you! A first time mother's posterior birth went well [with] a short labor. Membranes ruptured about 8am. Her labor started about 6pm: 3cm dilated; LOP station -1; cervix soft and effaced. 

We did rebozo sifting, sidelying release, abdominal lift and tuck, standing sacral release, Dip the hip, circling on the birth ball, lunge and she birthed at 9.58pm in sidelying position with hands around the husband's neck.

Baby's head showed more molding on the right side. What you taught in the workshop and website made a difference!

Chiew Gin, Doula, Singapore