When Labor Does Not Lead To Birth: Part 2
Read our 4 part story about long labor scenarios, posted every Wednesday.
If the system was not broken, we could transport these cases before we get to the point of necessity. But since the system is broken, and we can’t transport in the middle of a long labor and ask for Pitocin, we hesitate to transport until we absolutely have to. If all vital signs are normal for baby and mother, fluid is clear if membranes have ruptured, and the mother and family are wanting to continue to attempt a home birth, slow progress is not a reason for transport. Most of the babies born at home would not have been born there if that were the case. Many labors progress much more slowly than the labor curve that is generally adhered to in the hospital. It is called Friedman’s curve and has since been discredited and replaced with more evidence-based guidelines. These guidelines include diagnosing failure to progress in first stage labor (the dilation phase) if a woman has achieved 6 cm (active labor) AND her water is broken AND she has had 4 or more hours of adequate contractions with no cervical change.
Every birth worker has heard the stories of women laboring for days and/or pushing for hours with a successful home birth outcome. Therefore, it is frustrating to be in this scenario without the ability to really take advantage of the tools (like Pitocin) that are available at the hospital. We live in an area of the country where there seems to be a cesarean epidemic. Our clients are afraid of the hospital and we lack the friendly relationship of our colleagues that would allow the option of transport for labor augmentation without the fear of a retaliatory attitude.
Where are the home-birth friendly hospital providers? Why don’t the labor and delivery hospitalists get to know their home birth counterparts to effectively improve the outcomes for home birth clients?