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Giving Birth Takes Longer Today Than It Did 50 Years Ago: Study

Posted: 04/ 3/2012 1:06 pm

Convinced that you spent a lot more time in labor with your baby than your mom did with you?

You may have.

According to new research from the National Institutes of Health, moms take significantly longer to give birth today than they did 50 years ago.

The study, published online in the American Journal of Obstetrics and Gynecology, compares data from tens of thousands of women in the late 1950s through the mid '60s with nearly 100,000 women between 2002 and 2008.

First-time moms in the latter group spent two-and-a-half more hours in the first stage of labor, the period of time it took them to go from 4 centimeters to fully dilated. Among women who had already given birth, that stage lasted just shy of two hours longer.

"We can't fully explain it," said Dr. Katherine Laughon, lead author on the study, who is with the epidemiology branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. "One thing we do know is that epidurals have increased."

Indeed, Laughon and her co-authors posit that changes in obstetric practices could be one of the major factors fueling the change.

More than half of the women in the "modern" cohort had an epidural, versus just 4 percent of the 1960s group. Epidurals have been shown to lengthen labor times -- a 2002 American College of Obstetricians and Gynecologists bulletin said they can prolong labor times by 40 to 90 minutes, while a 2001 study put the average at closer to 25 minutes.

"Clearly, epidurals don't fully explain the 2.6-hour increase," Laughon said.

She also pointed to induction, which she thinks could be another contributing factor. More women today undergo labor induction than in the past.

On average, infants in the contemporary group were also born five days earlier.

"It's surprising, I think, because some people thought that with all of our new controls, and with the use of induction, we'd see shorter times," said Eugene Declercq, a professor in community health services at Boston University. "But that may be counterbalanced by the use of epidurals."

Importantly, moms themselves may also have changed since the 1950s. When comparing the two groups, researchers found that mothers giving birth nowadays had higher body mass index -- a measurement of their weight relative to their height -- and were also several years older. Their babies also tended to weigh more -- all factors that could contribute to longer labor times.

But some experts caution against jumping to conclusions, particularly given limitations in the two data sets.

"The studies compared here have very different patient populations and they are two different study designs," said Dr. Emily DeFranco, an assistant professor in maternal fetal medicine at the University of Cincinnati, who added that the study cannot draw firm conclusions about the possible role of changing obstetrical practices, as it was not designed to look at them specifically.

"I think the way I would interpret it is to say that there are two different studies that have been done that propose what a 'normal' labor curve should look like," DeFranco continued. The current paper suggests that a normal, healthy labor may be slower than previous estimates suggested. Using that looser timeframe, DeFranco said, doctors may be less likely to intervene with a C-section, which are often performed when a woman's labor isn't progressing fast enough.

The authors of the current study agree that further research is required to determine what is driving changes in labor times -- whether it is practice patterns, shifting maternal demographics, or some combination of factors. If that research does support the current findings, Laughon said, it could signal a compelling need to revisit routine interventions.

As for what this means, right now, for expectant mothers?

"This probably all matters a great deal if you're in labor," said Declercq, suggesting that this is data women may want to consider when making decisions about their epidural use, for example. "For me, sitting in my office at my desk, two hours may not seem like much. But for a woman in labor, it is very different."

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Convinced that you spent a lot more time in labor with your baby than your mom did with you? You may have. According to new research from the National Institutes of Health, moms take significant...
Convinced that you spent a lot more time in labor with your baby than your mom did with you? You may have. According to new research from the National Institutes of Health, moms take significant...
 
 
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12:44 PM on 05/12/2012
Medicalized birth is a self perpetuating social and economic pathology that imprints the baby with trauma. Not a good idea. See "hispanic paradox" on wikipedia.
01:42 AM on 04/18/2012
I believe it is the epidurals that are causing births to last longer. I am all for natural birth, and even unassisted birth... check out Laura Kaplan Shanley's latest book, "Unassisted Childbirth." Interesting concept given the fact that our ancestors used this technique back in their day.
http://www.unassistedchildbirth.com
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Ty2010
12:56 PM on 04/10/2012
Sounds like the results of a government plan to reduce labor time, maybe lawyers need to get out of the way.
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Rubyfoo
02:00 PM on 04/04/2012
The babies are hanging back until after the Republican convention this summer.
10:34 AM on 04/04/2012
"Failure to Progress?": Here is a humorous 60 sec. video about why births might take longer: http://www.youtube.com/watch?v=N5J3o6AvSq4
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
01:35 AM on 04/04/2012
epidurals have increased as have induced labors...better to wait for the baby to decide when it wants to come, unless it is over two weeks "late"...
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Mira59
Observe your nap time
11:23 PM on 04/03/2012
Women were a lot more active. There were fewer cars on the road....walk, walk, walk. The acceptable weight gain for pregnancy was 30 lbs or less and now it is 50. Women were younger, babies were smaller. Insurance rates for obstetricians were low.....and women had a lot more freedom while in labor, unlike now when you are strapped down with monitors the minute you step into the hospital.... for safety. Yet women die today just as they did 50 years ago. A young woman we know died recently after having had a baby and after being sent home, died of a ruptured liver. Such a tragedy.
11:11 PM on 04/03/2012
One reason could be that our mothers got alot more exercise then the pregnant women of today.
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VA Jill
I'm not perfect and neither are you
10:05 PM on 04/03/2012
Epidurals and inductions...especially the latter.
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01:43 AM on 04/04/2012
Yup and the labor with an inducement is so much more painful.
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VA Jill
I'm not perfect and neither are you
02:33 PM on 04/04/2012
When I had my last one, I was feeling tired and a bit grumpy and wanted things to hurry up (don't we always?). The doc suggested putting me on a pitocin drip and I glared at him and said "Over my dead body...and yours!" It was my 4th baby and I knew how my body worked by then so I asked him to break my water, informing him that I could probably promise him a baby in a couple of hours. He grumbled and grumped and was a LOT rougher than necessary. Baby arrived in 1 hour 36 minutes. He never made it to the delivery. I advise against induction whenever possible.
09:35 PM on 04/03/2012
Epidurals may have a lot to do with the increased time of labor. Epidurals slow down the effects of endogenous oxytocin (this hormone is what acts on the uterus muscles causing contractions).
The earlier an epidural is given during first stage labor, the longer the labor is going to last. The other issue is the number of women asking to be induced for convenience reasons not because of medical reasons. Many hospitals in the US use low does synthetic oxytocin infusions rather than high dose; many developed countries are currently using the high dose with better results and less complications. The low dose may be a contributing factor as well as when you induce labor, the body was not ready on it's own so it's going to take longer. I just completed research on this topic for a medical project suggesting that women wait until 39 completed weeks and have a minimum score of 8 on cervix/pelvic readiness before they are induced. These guidelines are being implemented specifically because of long labor times and to prevent other complications in the mother and the baby. Women 40-50 years ago waited for labor to start on it's own, todays women want to be able to plan everything including time in labor. If there are no medical conditions requiring inducement, waiting for labor to start is the best choice.
08:29 PM on 04/03/2012
There are about a million reasons that labors could take longer (better monitoring, babies actually making it to term that otherwise would have been lost to preterm labor, etc.), but one has to look at a bigger and even more important statistic - the rate of survival for both the mother and child during Labor and Delivery compared to the 1960's. I'll take the longer deliveries than an increased death rate! Also, with my first I white-knuckled trying to go "naturally" to the point that in the end it took far more medication, interventions, and over doubled the time it took to deliver my 9lb.4oz. daughter (36 hours) than what it took to deliver my 9lb.1oz. son (17 hours) with the attitude of "they've got a drug for that". Both were also inductions whereas the earlier years studied it was not at all unusual to allow babies to go as long as they wanted to stay in.
08:21 PM on 04/03/2012
Is there any mention of birth weight in these studies? Doctors 40 and 50 years ago didn't like women to gain much weight while pregnant. I know all four of my mother's babies weighed less than my two.

I agree with other posters who think inductions have a lot to do with longer labor times too. Babies should come when they are ready and not according to someone's schedule.
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dugandob
09:04 PM on 04/03/2012
That's a good point. Women weren't as heavy as they are now when giving birth. All Three of mine were induced labor. And my babies were 10lb90z,9lb10oz,&8lb9oz. I did gain more weight but lost it after the babies were born.
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Hannah Knise
I can procrasturbate in heels.
09:23 PM on 04/03/2012
Your forget some women need it or they could die. But I guess me being induced because I had pre-eclampsia makes me a bad mom because I made her come out before she was ready. Top it all off with my epidural and c-section and I must be hung right?
10:21 PM on 04/03/2012
There's a reason why we have the intervention practices that we have. You have just given us one of those reasons. People tend to forget that the death rate of women (and infants) in childbirth was actually pretty high. It was one of the leading causes of death for women. (Along with plague and witch-hunts...) For the record, I'm glad you're "not quite dead yet!" I think what people are saying, though, is that any practice can be misused. As always, education is needed to make an informed decision ~ especially for something so personal as giving birth.
11:24 PM on 04/03/2012
I don't believe I said anything about inductions for valid medical reasons - of course those are necessary. I'm talking about OB practices that routinely induce most of their patients leading to more C sections. When my children were born (25 and 30 years ago) very few babies were induced. Now practically every woman I know who is near her due date (not past it) is talking about their doctor is going to induce them if the baby isn't born before the due date. I think nature knows when most normal, healthy pregnancies are at an end and babies should be born when they are ready and not because the doctor has three other inductions scheduled that day. And I work in the medical field so don't think I have anything against doctors.
08:03 PM on 04/03/2012
I wonder if the increased labor time has something to do with the increased instances of induced labor. In general, it takes longer that way, and It's fairly common these days for the doctor to just schedule the day baby is going to be born when its convenient.
09:47 PM on 04/03/2012
You have hit the nail on the head. As the father of 7& grandfather of 11 I have observed the fact that women are seldom allowed to carry their babies until the baby is ready to come out. The scheduling of births have become the norm. Little wonder that the process takes longer when Doctors start before nature is ready. The days of a woman being sent home after an examination and being told "not yet" are probably only in the experience of your great-grandparents. Rest assured that if you drag the doctor out of his cozy home for an unscheduled trip to the hospital you WILL be having that baby. Harder on the infant and harder on the mother, and America has one of the highest rate of mortality during childbirth of developed nations. Doing research on the subject revealed many depressing statistics when compared with other nations ,both for the mother and the health of the baby. Personally. I was infuriated years ago when I learned all this 'the hard way'. Patience and waiting for nature to do what's best for the infant is out of the question in the babyfactory approach nowadays.
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
01:40 AM on 04/04/2012
hold on grandpa. i was told to go home in 1982 when my daughter wasn't quite "done" yet! and it isn't always the doctor's convenience...moms are just as much to blame!
01:05 PM on 04/04/2012
I was sent home in 2008 when I had gone in after an entire day of labor pains and only 1 CM to show for it. It still happens but I agree it probably doesn't happen as often as it should.

I ended up delivering about 15 hours later. My trip home was short lived. :)
07:02 PM on 04/03/2012
When I went into labor my nurse would not stop trying to push me into getting an epidural. She kept telling me to get it over and over every time she'd come into my room even though I turned her down every time and did so for the whole thing. Maybe the hospital just wanted to try to get the extra money from the pain medication but the pain wasn't anything I couldn't handle and to be honest I personally didn't think it was that bad as everyone seemed to always make it out to be, but it could just be that over the years I've learned to handle very painful periods and for a large part of the labor that's all it felt like to me. Still took me 13hrs from start to finish though Lol.
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undrgrndgirl
what's so funny 'bout peace, love & understanding?
01:44 AM on 04/04/2012
having worked l&d i'd say you are in the minority and there is nothing more frustrating to the nursing staff than a patient who refuses an epidural then decides after it is too late that she really wanted one...and b.itches you out for the rest of her maternity stay saying the nurses "wouldn't let her have one"...patients don't understand you have to get the anesthesiologist there, the procedure take a few minutes to half an hour or more (depending on how cooperative the patient is) and takes more than a few minutes to fully numb the lower half of the body.
01:00 PM on 04/04/2012
That would be a nightmare to deal with. I don't envy nurses that.
01:02 PM on 04/04/2012
When I did my preliminary paperwork at the hospital several weeks before I was due I told them that I was going to try to do it naturally and would appreciate that they not ask me about it. It was part of their questionnaire.

As it turned out, I showed up at the hospital too far along for it to matter but I was happy they gave me the option to voice my opinion beforehand.
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camoore5
family~the most important thing ever!
05:55 PM on 04/03/2012
I took the pain until I just couldnt take it no more and then it was epideral time. I would rather spend a few more hrs in labor and get to enjoy the whole process than to be in all that unessessary pain.