Tuesday, March 18, 2014

C-sections & Friedman's Curve

Can you believe Brittany's story? Seriously, when I complain of an ache or being uncomfortable I just think about Brittany and shut the hell up, lol.  She is a super hero in my eyes!  Now, Brittany's situation was the TRUE definition of a medically necessary c-section...sometimes this gets a little murky.

According to Evidence Based Birth :

“Failure to progress” is the number one reason for unplanned C-sections in the U.S.   More than 4 in 10 women who had C-sections for failure to progress had not even reached 5 cm dilation before they were taken to surgery. This means that many of women were still in very early labor when they were told that they weren't dilating fast enough (Boyle, Reddy et al. 2013). 

THEY ARE RUSHING US!

researchers found that about half of all induced women who had C-sections for failure to progress had not reached 6 cm yet (53%)– indicating that they were still in very early labor when their inductions were labeled as “failed” (Zhang et al., 2010b). First-time mothers who are induced at term for no medical reason have a C-section rate of approximately 24%, with the largest percentage of these Cesareans being performed in early labor—before the woman reaches 6 cm (Laughon et al. 2012).  Studies have found that there are no harmful effects to the baby if a woman is given more time to labor with an induction. Researchers have shown that women who are induced are more likely to have longer early labors than women who go into labor on their own (Harper et al. 2012)


STOP RUSHING US!  We are all different women, with different body types, different pain tolerances, different preferences for intervention in birth.

STOP BASING MY LABOR ON A STUDY DONE 
60 YEARS AGO!
Friedman's Curve is no longer relevant! 



So what is this Friedman’s curve? When was it invented? Does it apply to women today?
In 1955, Dr. Friedman of Columbia University published a study describing the average amount of time it took women to dilate during labor (Friedman 1955).  Dr. Friedman’s study focused on 500 first-time mothers who gave birth at term in 1954.  96% of the women in this study were sedated with drugs.  Dr. Friedman plotted women's labors on a graph, and then figured out the average length of time it took to a woman to dilate each centimeter. This graph became known as the famous “Friedman’s Curve.”
Although it was published nearly 60 years ago, Friedman’s curve still serves as the basis of how most physicians define normal labor (Gabbe, Niebyl et al. 2012). In fact, as recently as 2010, researchers claimed that Friedman’s curve continues to “govern labor management.” In other words, most care providers use this graph to dictate how they manage a woman’s labor (Zhang, Troendle et al. 2010).
Modern researchers have come to the definitive conclusion that we can no longer apply Friedman’s curve to women of today’s world. Too many things have changed since 1955. Women are no longer sedated during labor, but epidurals are commonplace; Pitocin is used much more frequently for both labor induction and augmentation, women are older and tend to weigh more, and forceps are hardly ever used. All of these things can either slow down or speed up the rate of labor.
Blow your OB's mind and ask them their views on Friedman's Curve! 

Now, I have had conversations with women that say they WANT a c-section, to which I could not even muster up a reply, just smiled and someone, thankfully, changed the topic.  That is her right and my silence was me trying to be respectful of her preference.  I just cant help but think its based on fear though and that kinda breaks my heart....I want to hug her and tell her she is tougher than she thinks and to not be afraid.
There are reasons to NOT want a c-section if you can help it...one of them being it affects formation of their microbiome...read more here.
It also can interfere with hormone exchanges after being born. Did you read this?
It can also reduce your chances of breastfeeding successfully.
I know c-sections are not the end of the world, and there are tons of sweet healthy babies born via c-section every day.   I'm not saying c-sections are the devil,  but if its something in particular that YOU hope to avoid I have armed you with some extra info- just by you knowing all this will decrease your chances of a c-section. You will not be fooled by "failure to progress" and you will not be afraid to tell the Doc you want more time.