In multiparous women, perinatal outcome was significantly better for planned home births than for planned hospital births, with or without control for background variables.
On the basis of the 95th percentile threshold, historically, the latent phase has been defined as prolonged when it exceeds 20 hours in nulliparous women and 14 hours
in multiparous women (18).
The duration of the second stage of labor and its relationship to neonatal outcomes has been less extensively studied
in multiparous women.
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).
Given the available literature, before diagnosing arrest of labor in the second stage and if the maternal and fetal conditions permit, at least 2 hours of pushing
in multiparous women and at least 3 hours of pushing in nulliparous women should be allowed (Table 3).
Not exact matches
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.
Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outc
Women planning birth
in a midwifery unit and
multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outc
women planning birth at home experience fewer interventions than those planning birth
in an obstetric unit with no impact on perinatal outcomes.
For
multiparous women there was no evidence of a difference
in the primary outcome by planned place of birth.
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
For
multiparous women, there were no significant differences
in the primary outcome between birth settings.
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).
With regards to maternal outcomes
in nulliparous and
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.
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).
No difference
in long - term outcomes for planned home versus planned hospital births for
multiparous 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).
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).
Researchers have found that after a 3 - hour or more second stage of labor, only one
in four nulliparous
women (27) and one
in three
multiparous women give birth spontaneously, whereas up to 30 — 50 % may require operative delivery to give birth vaginally
in the current second stage of labor threshold environment (30).
However, the
multiparous women in our study were at low risk and their history would not have prompted referral to an obstetrician.
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.
Primiparous
women and
multiparous women were considered separately because of well known differences
in outcome.
Multiparous women were more likely to choose a hospital birth if they belonged to an ethnic minority; had a non-optimal body mass (Quetelet index outside the range 18.8 - 24.2; P < 0.05); had a history of obstetric complications, preterm birth, or instrumental delivery; or had received medication (including vitamins and iron)
in pregnancy (table 2).
Percentage non-optimal characteristics
in the perinatal background index among planned home and planned hospital births
in primiparous and
multiparous women
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.