However, no evidence - based programme is available
for multiparous women or older first - time mothers.
Of women in our study with prolonged second stage diagnosed, 20.5 % were delivered in less than 3 hours (for primiparous women) and in less than 2 hours (
for multiparous women) from the time of complete dilation.
For multiparous women, the most common indication was fetal malpresentation (25.8 %), followed by nonreassuring FHR tracing (24.6 %) and failure to progress (19.5 %).
Rates of cesarean section
for multiparous women, when women with previous cesarean sections were excluded, were not different (p value cut - off for statistical significance after the Bonferroni correction 0.002).
The vaginal delivery rate for women who had not progressed despite 2 hours of oxytocin augmentation was 91 %
for multiparous women and 74 % for nulliparous women.
In this study, the 95th percentile rate of active phase dilation was substantially slower than the standard rate derived from Friedman's work, varying from 0.5 cm / h to 0.7 cm / h for nulliparous women and from 0.5 cm / h to 1.3 cm / h
for multiparous women (the ranges reflect that at more advanced dilation, labor proceeded more quickly)(Table 2).
No difference in long - term outcomes for planned home versus planned hospital births
for multiparous women.
Overall, and
for multiparous women, planned birth at home generated the greatest mean net benefit with a 100 % probability of being the optimal setting across all thresholds of cost effectiveness when perinatal outcomes were considered.
However, higher rates of a composite outcome of perinatal morbidity and mortality were seen for nulliparous women having homebirths (adjusted odds ratio 1.75; 95 % CI, 1.07 — 2.86), with no differences
for multiparous women.
For the three non-obstetric unit settings, transfer rates were much higher for nulliparous women (36 % to 45 %) than
for multiparous women (9 % to 13 %)(table 2 ⇓).
Transfers from non-obstetric unit settings were more frequent for nulliparous women (36 % to 45 %) than
for multiparous women (9 % to 13 %).
For multiparous women, there were no significant differences in the primary outcome between birth settings.
For multiparous women there was no evidence of a difference in the primary outcome by planned place of birth.
Not exact matches
: «1.1.1 Explain to both
multiparous and nulliparous
women who are at low risk of complications that giving birth is generally very safe
for both the
woman and her baby.
1.1.2 Explain to both
multiparous and nulliparous
women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth: Advise low ‑ risk
multiparous women that planning to give birth at home or in a midwifery ‑ led unit (freestanding or alongside) is particularly suitable
for them because the rate of interventions is lower and the outcome
for the baby is no different compared with an obstetric unit.
Homebirth is recognised as safe
for low risk
women, particularly if it is not the first time they are giving birth (i.e. slightly higher risk
for primiparous
women than
multiparous) as per «Birth Place Study» — British Medical Journal 2011 — amongst other studies.
For healthy
multiparous women with a low risk pregnancy, there are no differences in adverse perinatal outcomes between planned births at home or in a midwifery unit compared with planned births in an obstetric unit
The caesarean rate
for intended home births was 8.3 % among primiparous
women and 1.6 % among
multiparous women.
This decision uncertainty surrounding the most cost effective option was not found
for place of birth in
multiparous low risk
women without complicating conditions, in whom planned home birth had a 100 % probability of being the most cost effective option across all thresholds of cost effectiveness (table 4).
This decision uncertainty surrounding the most cost effective option was not found
for place of birth in
multiparous low risk
women, on whom planned home birth had a 100 % probability of being the most cost effective option across all cost effectiveness thresholds between # 0 and # 100000 (table 3).
For example, the recent Eunice Kennedy Shriver National Institute of Child Health and Human Development document suggested allowing one additional hour in the setting of an epidural, thus, at least 3 hours in
multiparous women and 4 hours in nulliparous
women be used to diagnose second - stage arrest, although that document did not clarify between pushing time or total second stage (33).
A prospective study of the progress of labor in 220 nulliparous
women and 99
multiparous women who spontaneously entered labor evaluated the benefit of prolonging oxytocin augmentation
for an additional 4 hours (
for a total of 8 hours) in patients who were dilated at least 3 cm and had unsatisfactory progress (either protraction or arrest) after an initial 4 - hour augmentation period (21).
Using this tool we compared the outcomes of planned home births with those of planned hospital births
for primiparous and
multiparous women after controlling
for the confounding effects of social, medical, and obstetric background.
Power analysis, based on detecting a significant difference in the combined frequency of non-optimal factors during and after childbirth, led us to aim
for a sample size of 1600
women, with approximately half being
multiparous and preferably half choosing hospital birth.
A closer look at the background characteristics shows that
multiparous women with a complicated previous pregnancy, including instrumental delivery in our study, were more likely to opt
for hospital birth than
for home birth.
These risks may differ among different
women (
for instance, nulliparous vs.
multiparous), and
women should understand what the risks are so that they can make informed decisions about their personal circumstances.
In
multiparous women, perinatal outcome was significantly better
for planned home births than
for planned hospital births, with or without control
for background variables.
Among
women who had a primary cesarean delivery
for failure to progress, 42.6 % of primiparous
women and 33.5 % of
multiparous women never progressed beyond 5 cm of dilation before delivery (Table 3).
For primiparous
women, it was assumed that the scars represented previous myomectomies, but the higher rate among
multiparous women suggests that some primary cesarean deliveries actually may have been repeat cesarean deliveries that were recorded incorrectly.