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Researchers question new guideline meant to decrease C-section rates

A controversial new guideline about the correct amount of time to let a mother labor during the second stage faces professional criticism.

Two professional medical organizations have recommended a change to their labor and delivery guideline that is currently based on decades of experience and observation. The American Congress of Obstetricians and Gynecologists, known as ACOG, and the Society of Maternal-Fetal Medicine plan a guideline change that will lengthen the recommended time a woman can safely be in active labor before intervention like a Cesarean section, or the use of forceps or vacuums to assist the baby in moving through the birth canal, preventing harm to the mother or baby from arrested labor.

Specifically, the recommendation is to increase the accepted upper limits of second-stage labor, meaning the time from when the mother’s cervix is fully dilated until the baby is born, a time of intense contractions that includes pushing the baby out.

The guideline limit has been that the second stage should not be allowed to continue beyond three hours for a mother who has not previously given birth and who has had an epidural. The new recommendation for this kind of patient is to increase the limit to four hours.

For a mother who has given birth before who has received an epidural, the recommendation is to increase the limit from two to three hours. Increases are also planned for mothers who have not had epidurals.

Articles by prominent physicians highly critical of the new recommendations have appeared in the American Journal of Obstetrics and Gynecology.

The guideline change reportedly grew out of a professional conference that considered ways to address the increasing rate of C-sections. The goal of the new guideline is to decrease the rate of C-sections by letting women actively labor longer to see if vaginal births are safely possible instead of intervening earlier, but a chorus of professional voices are sounding the alarm that the guideline change may be premature, requiring more research and observation before implementation.

The new guideline is based largely on medical research by Jun Zhang and others. However, that research has been hotly contested by other doctors, who question the methodology of the research relied on by ACOG as well as the lack of robust data on which to base the change, in contrast to the decades of observations on which the old guideline relies. Critics are concerned about potential safety risks of letting labor go too long without intervention. Significantly, researchers question whether the emphasis in the Zhang study on statistical curves is too rigid and may not take into account the subjective and unique factors of every birth.

Considering the emphatic professional concerns, whether the new guideline should be adopted is a serious question. The bottom line is that when labor is allowed to continue too long, sometimes serious harm can result to the mother like hemorrhage, uterine rupture, pelvic injury and death, and to the child such as brain injury, cerebral palsy, shoulder dystocia, Erb’s palsy, other severe disabilities or even stillbirth.

When a mother or baby is harmed during the labor and delivery process, the family should consult with an experienced attorney to understand potential legal remedies such as a medical malpractice lawsuit, if appropriate. It is especially important given the controversy surrounding the new guideline to retain a lawyer who is familiar with the developing professional disagreements about what the correct standard of care is during the second stage of labor, as this standard could be crucial in a suit, depending on the circumstances.

The medical malpractice lawyers of Lancione & Lancione, LLC, in Columbus and suburban Cleveland, represent parents and children across the state of Ohio who have been harmed during the labor and delivery process.

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