Saturday, June 30, 2007

Active management of long labors

The other day I had the privilege of attending a Metropolitan Doula Group (MDG) meeting at which midwife Cara Muhlhahan spoke about managing long labors. [I'm in New York for 2 weeks, heading to Texas for some family time, and then back to Bangalore at the end of July.]

Cara emphasized the importance of not pathologizing long labors. When the baby is in the occiput posterior (OP) position (back of the baby's head is facing the back of the mother, accounting for about 15-30% of labors), latent labor can last three to four days while the baby's head molds to fit into the mother's pelvic opening. Long labors are not harmful to mothers or babies, rather, they are physiologically normal. The head must mold before the cervix can open, and it's best to simply wait it out without wearing the mother down or suggesting that the she is at fault.

Cara pointed out that women are looking for any excuse to believe they are inadequate. It's no wonder sometimes, when you look at hospital practices, in the case of long labors, for example. Most doctors would never let a woman labor for three days. She would be called in to the hospital, given Pitocin to augment the labor, and the cascade of interventions would begin, potentially leading to a cesarean birth.

We know this happens often in many hospitals, including those in Bangalore, where cesarean rates tend to reach 70%. (The world health organization (WHO) recommends a safe target rate of 10-15%.)

It was pretty amazing to be back at an MDG meeting; more than twenty doulas attended, including a few from the Brooklyn group I'd been hosting at my apartment in New York last year. I miss going to regular meetings and consistently having opportunities to share information and get support and inspiration from like-minded colleagues in the birthing field. I hope this blog serves to connect people interested in normal birth, both new and expectant mothers as well as childbirth professionals.