Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear
Make Labor Longer?
Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.
The American College of Obstetricians and Gynecologists and The Society for Maternal Fetal Medicine (aka high-risk obstetricians) have issued a new recommendation that is a game-changer in the manner that obstetrics is practiced: allow low-risk first-time pregnant moms more time in labor. This is assuming that the fetal tracing is normal and the mother does not have a fever, high blood pressure or a condition that could compromise her life or the life of her unborn baby. This recommendation is based on new evidence that demonstrates contradicts the old school Friedman Curve theory that active labor begins at 4 centimeters. It actually begins at 6 centimeters. This would be especially helpful to first-time teenage moms who might be forced to have future cesarean sections based on hospital rules and physician opinions if their first delivery was a cesarean section. The “once a C-section, always a C-Section” culture hits this particular group the hardest.
Today will be a day of mourning for pregnant women who are uninsured and receiving Medicaid in Houma, Louisiana. Their local hospital closed its maternity and neonatal units because of a $2.9 million dollar budget cut. Over 100 employees will lose their jobs, many whom have held their positions for over 20 years. This closing will have a ripple effect and is an increasing phenomenon that has besieged many hospitals across our nation. Over thirteen hospitals in Philadelphia closed their labor and delivery departments and in my own backyard, South Seminole Hospital in Florida did the same. What’s going on? Hospitals claim they’re losing money and government insured and non-insured pregnant women are feeling the aftermath. These are some very scary times.
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
In Native American culture there is a premise that Nature thrives on order but it is man who creates the disorder. That thought came to mind last month when I presented yet another malpractice case for review with a panel of colleagues. A patient wanted to be induced at 39 weeks and inevitably had significant complications with a poor birth outcome. In my expert opinion, I suggested that the physician should have waited until the patient was 41 weeks before she attempted an induction and one of my colleagues thought that I was vehemently wrong. “She was full-term and entitled to an induction” he practically shouted in my ear. “That’s not the point,” I countered. There was no reason to do the induction except for physician and maternal convenience. I reminded him that most high-risks specialists will start fetal monitoring and nonstress tests (NSTs) at 40 weeks to document fetal well being and then induce labor at 41 weeks if it has not started spontaneously.