One of my proudest moments as a labor and delivery nurse happened in the middle of the night, racing against the clock with a doctor who felt certain my patient was heading for a C-section.
The poor mother was tired and discouraged and her baby seemed stubbornly stuck up in the birth canal with no plans of coming down anytime soon. The patient knew there was talk of “the cut” swirling around, so I watched her deflate like a soggy water balloon right there in that hospital bed. At the nurse’s station, the doctor instructed me to gather up the paperwork for a C-section and prepare my patient for what seemed inevitable.
But I felt, deep down, that she could do this on her own.
I could see it in her eyes that she wanted to do this on her own. And if anything, I wanted to spare her what would be a much more difficult recovery process if at all possible. Why get major surgery unless it’s absolutely necessary?
So I begged him for just one more hour. Just one, I pleaded, and if I couldn’t get that baby down still, then we could have her ready in five minutes. He begrudgingly gave me an hour (probably long enough to sneak a nap in in his eyes!) and I worked with that patient to the point where we were both sweating. I swear to you, it felt like I was pushing that baby alongside of her. But that little spark that I saw in her eyes flamed into a burning strength and man, did she deliver when it counted the most.
Exactly one hour later, that baby was crowning, the doctor was summoned, and the next thing you knew, he was snapping his gloves on and shaking his head.
“Wow,” he said. “You did it.”
I’ve never forgotten that moment, small as it may seem, because it felt like a victory to not only help that mother find the strength she needed inside of herself, but to help her avoid the pain and complication of an unnecessary C-section. I’m no dummy — I know C-sections save lives, and there’s no debate that C-section mothers are “real” mothers. Birth is birth is birth. But a surgery is also a surgery, and if it’s in the mother and baby’s best interest to deliver vaginally, then by golly, I think you should do everything you can to make sure that happens.
And a new study says that more moms, like my patient, could deliver vaginally if given the opportunity. And like my patient, the shocking part is that many times, all they really need is just one measly hour to push — and they too could avoid getting an unnecessary C-section.
The American College of Obstetricians & Gynecologists is, in theory, pretty good about giving women enough time to get through the first stage of labor, which can take a long time, but when it comes to the actual length of time doctors let women push, things get a little dicey.
Currently, guidelines set by the ACOG have different standards for exactly when women should get a C-section, and while there is some wiggle room, in general, the rule of thumb is that it’s not best practice to let women push for more than two hours. First-time moms and moms with an especially potent epidural (translation: they can’t feel a damn thing to push effectively enough) may get a little more time, but the ACOG notes that three hours is usually the max for even first-time moms to push.
Doctors go on a case-by-case basis, but if things seem to be stalling or the baby is showing any signs of distress, it’s off to the C-section suite. These recommendations are based off of the association between a longer second stage of labor and morbidities to both mom and baby, with the big “but” of that association being that it’s not clear if it’s because of the longer times some moms take or because of the doctor’s interventions as a result of a longer stage. Totally unclear and totally not comforting either way you slice it.
But this new study gave women — all of whom had epidurals, mind you — just one extra hour to push and found that the C-section rate dropped by more than half. And more importantly, there weren’t any changes in the baby’s outcome or other health complications either, although the study’s authors did note that they didn’t have the funds to look at every last possible complication.
And while this all sounds like tremendous news, experts are cautioning that they don’t think the standards for pushing time will change automatically just because of one study. The study is, however, promising new evidence that we need to give moms a little more time and faith to get the job done before intervening. Save the C-sections for when they are truly necessary and everybody wins.