When is an induced labor “prolonged”? (Your guess is as good as mine.)
I seriously have no time to blog right now. I’m flying to Orlando for the Lamaze Conference this afternoon, and there’s plenty on the to do list still! But I was putting the finishing touches on my powerpoint talk this morning and I had to get a little something off my chest. My talk is called Optimizing Labor Progress: What the Research Does and Does Not Tell Us. I of course include a section about how we define labor progress (debunking the Friedman Curve, etc.) At the last moment, I added this slide:
That’s right, we have essentially no data on how “normal” labor should progress when labor is induced. And in fact, the recent Practice Bulletin describing the clinical management of induction of labor put out by American College of Obstetricians and Gynecologists provides no guidance on how to assess or promote healthy progress in induced labors. The Practice Bulletin also provides no information to help providers or women themselves determine when the harms of cesarean surgery are outweighed by the benefits of getting a baby out sooner. The only thing ACOG has to say on the matter is this:
Labor progression differs significantly for women with an elective induction of labor compared with women who have spontaneous onset of labor. Allowing at least 12–18 hours of latent labor before diagnosing a failed induction may reduce the risk of cesarean delivery. (p. 698)
ACOG cites only one study to support the fact that induced labors don’t progress the same way that spontaneous labors do. That study was undertaken in first time mothers undergoing elective induction, hardly a group whose outcomes can be generalized to all induced labors.
I’m just wondering, how are clinicians supposed to make rational decisions about when to recommend a cesarean in an induced labor? And how are women to know whether to go along with those recommendations? I have a feeling I’ll be blogging about this again soon.
Off to Orlando!