Could caesarean rates be cut if women were given longer to labour?

Caesareans are a very touchy subject. As soon as anyone talks about the rate being too high, women will jump in with their stories about how a caesarean saved their life or their baby’s. There’s no doubt that c-sections are lifesavers and have done a huge amount to lower the number of deaths in childbirth.

At the same time, when caesareans aren’t medically necessary, straightforward vaginal births have advantages for mothers and babies.

Listen: Monique Bowley and Bec Judd talk to Midwife Cath Curtin about whether or not you can have a c-section if it’s not medically necessary. Post continues after audio. 

Now, a new study from the US is suggesting that if women were given a little longer to labour, more of them would be able to give birth vaginally.

The American College of Obstetricians and Gynaecologists says that first-time mothers are generally given three hours to push their baby out in the second stage of labour. Beyond that, they’re considered to be experiencing a prolonged second stage, and intervention may be needed.

But this new study, carried out on 78 first-time mothers at Thomas Jefferson University Hospital in Pennsylvania, found that if women were given just one more hour to push, caesarean rates were halved.

Dr Alex Gimovsky, one of the authors of the study, says the time recommendation came from expert opinion in the 1800s. Research has proven that women today take longer to give birth than they did in earlier generations.

“The study really showed what we’ve seen in practice for years, which is that there can be benefits to allowing women to labour longer,” Dr Gimovsky says. “We were excited to see that it dramatically reduced the risk of c-section in this specific group of women.”

Listen to the full episode of our pregnancy podcast, all about birth stories, below. Post continues after. 

However, she cautions that the study was too small to show the potential harms of letting women labour for longer. She says more research needs to be done.

Meanwhile, in the UK, a new report has warned against caesareans being carried out on women before they're 39 weeks pregnant, unless there's a medical reason for it. In some UK hospitals, more than 40 per cent of women are having c-sections before their pregnancy has reached full term.

Early c-sections carry an increased risk of babies having breathing problems and needing to be admitted to intensive care.

“We are particularly concerned about the variation among the number of women having elective caesarean sections before 39 weeks without any clinical indication,” says Dr David Richmond, the president of the Royal College of Obstetricians and Gynaecologists.

Earlier this year, Dr Richmond called for a nationwide drive to reduce the number of first-time mothers in the UK having c-sections.

He says the increased rate of caesareans is being fuelled by a rise in the number of obese mothers, obstetricians' fear of being hit with a lawsuit if anything goes wrong during labour, and a small number of women asking to have c-sections.

What was your experience of having a caesarean?