Twin Labors Take Longer New Study FindsKatlyn Joy | 9, August 2013
Hold off on that c-section! You may not be in a stalled or prolonged labor after all, it may be that giving birth to twins takes longer than doctors previously expected. Researchers at the University of Illinois at Chicago compared 900 twin pregnancies to 100,500 singleton pregnancies to determine how the length and progression of labor differed.
The data came from several clinical centers in a national database and found that twins required one to three hours longer to complete the first stage of labor compared to singleton babies. The first stage of labor is when the cervix is dilating to the point of being open enough to pass the baby. The second stage of labor is when the delivery of the baby, or pushing the baby actually begins by the mother.
"Our data supports the suspected findings that labor progression of twin gestation is prolonged, compared to a singleton gestation," said study researcher Dr. Heidi Leftwich. "Doctors could let twins labor longer before calling it 'failure to progress.'" Leftwich is a maternal-fetal medicine fellow at the University of Illinois at Chicago.
The research means that doctors can safely wait a few more hours before defining the labor as "failure to progress". That would eliminate many cesareans, deeming them unnecessary as some simple patience and time would be all that would be required in many cases.
Researchers gauged the progression of labor by how long it took for the cervix to dilate a centimeter. The results were adjusted for variables such as mother's age and weight, baby's weight, and whether the baby was born to a first time mother.
While in singleton labors it took an average of 9.6 hours to have the cervix dilate from 4 centimeters to the fully dilated 10 centimeters, in twin labors it took 12.7 hours.
Doctors generally use a tool called Friedman Labor Curve to determine whether a labor is progressing normally and whether a c-section is indicated or not. This measurement is based on data on how long on average it takes a mother to dilate to 10 centimeters and birth the baby. However, this tool was developed in the 1950's and today's infants are heavier on average and mothers use epidural anesthesia often. Both an infant's weight and using an epidural is known to slow labors. Something else that in of concern for mothers of multiples is that this tool never took into account how labor generally progresses in twin deliveries.
This study also found that twins weigh on average 1.7 pounds less than singleton babies. Twins are more often born to older mothers and are the result of preterm labor more often than singletons.
The rate of c-sections with twins is twice that of singleton deliveries, which is why this research could have a big impact on whether mothers will be allowed more time to try a vaginal birth.
Other factors can affect whether a cesarean may be required with twin births, such as a breech birth.
Some researchers believe that twins may take more time to deliver because an overextended uterus cannot perform as efficiently as with singleton births.
Also, most twin deliveries involve epidurals so that should a cesarean be required in an emergency type situation, anesthesia can be delivered quickly and safely via the catheter already in place. However, should a mother want to try labor naturally, she can be assured general anesthesia can be administered quickly if needed in an emergency or crisis situation.
This study is also not the only one to raise the question of whether multiple births have a slower rate of progression. In 2000 a study out of Evanston & Prentice Womens' Hospitals an d Northwestern University Medical School in Chicago, Illinois determined that twin and triplet births are characterized as having slower active phase dilation and that the rate is inversely correlated to combined fetal weight.
Sources: LiveScience, FitPregnancy.com, National Institutes of Health (NIH)Katlyn Joy is a mother to 7 children, and a freelance writer. She earned her Master of Arts in Creative Writing and Poetry, and a Bachelor of Arts in English and was previously an adviser to new mothers on breastfeeding through a maternity home program. She currently resides in Colorado with her family.
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