New intervention decreases cesarean rate and improves maternal blood loss (Patient evaluations every 60-75 minutes during labor reduced Cesareans by 60%)

Medical Xpress / The Journal of Maternal-Fetal & Neonatal Medicine ^ | Mar. 23, 2022 | Ronald E. Iverson et al

[ConservativeMind]

New research from Boston Medical Center suggests that hourly patient evaluation and documentation of the birthing plan in the second stage of labor decreases the second-stage of labor duration, the rate of cesarean sections, maternal blood loss, and rates of hemorrhage and transfusion. Published in the Journal of Maternal-Fetal and Neonatal Medicine, the team identify hourly second stage documentation as a uniquely non-medical intervention performed proactively before delivery. Current interventions to reduce blood loss are typically done reactively post-delivery and there have been no proven interventions to decrease cesarean rates.

Patients with hourly evaluation and documentation had a likelihood of cesarean delivery of 8.2 % on average, down from 20.3 % without the intervention. This intervention also improved:

The duration of the second-stage of labor, reducing the average time by more than half to 98 minutes from 178 minutes The total blood loss, reduced to an average of 514 mL from 668 mL The hemorrhage rate, reduced by 7.4 % to an average of 12.5 % compared to 19.9 % The transfusion rate, reduced to 3.2 % from 5.6 % These differences in outcomes were also observed when the evaluation was performed and documented within every 75 minutes.

Every patient who delivers a baby vaginally experiences this "pushing" stage of labor. Cesarean rates and maternal morbidity typically increase with the duration of the second stage of labor. As part of a quality improvement project, the obstetrics team ensured that delivery providers were working closely with patients as they pushed. Results show that patients who had hourly evaluations had a decreased time to delivery, which may be part of the reason for the other improved outcomes.

[ConservativeMind]

Push your doctors or nurses to do this.

[ConservativeMind]

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[CheshireTheCat]

What’s the point of being in the hospital to give birth if a patient isn’t checked frequently to see if they should start pushing?

[Sacajaweau]

You would think this was already being done.

[fwdude]

You would think this was already being done.

Obamacare medicine. They have to cut costs somewhere.

[Trillian]

With the majority of my kids, I spent most of my labor at home. With my twins, the labor lasted an hour. Luckily, It happened after my weekly check up.

[RushIsMyTeddyBear]

Wow. I was in labor for a week with my first born while living in the UK. It was miserable and almost lost him.

I can’t imagine twins.

[bitt]

p

[R.I.chopper]

Labor and Delivery nurse from 1988-2015...We NEVER left the side of a patient in her second stage ( pushing) ...and frequently had 2 nurses in the room. We’d call the doc the we saw the head ( plus 3 station)...I don’t understand this article unless they mean the DOCS need to be more present in second stage?

[Cloverfarm]

Bless you ... looking back, it seems like the nurses did most of the care when I was having my kids. The youngest came so fast that one of the nurses shouted down the hall, “Stop Dr. (so and so)! I’m not delivering this baby on my own!”