Test could predict which mothers will need Caesareans

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A test which could stop women labouring for hours in the hope of a "normal" birth only to end up with a Caesarean section has been developed in Sweden.

Researchers have established that when high levels of lactic acid are measured in the amniotic fluid, it is unlikely the mother will deliver vaginally.

Measuring this acid could help decide whether to end a difficult labour and opt for a Caesarean earlier.

The test is being rolled out in a number of European hospitals.

Prolonged labours which end up in a Caesarean section are seen by many as the worst of all worlds.

In the UK, despite the mantra "too posh to push" more than half of Caesareans are emergency rather than elective procedures, in which the mother frequently undergoes a long and painful labour before an urgent operation is deemed necessary to protect the health of both her and her baby.

... the uterus produces lactic acid as other muscles do when they work hard, but that when it reaches a certain level the substance starts to inhibit contractions.

... The hormone oxytocin is usually administered in cases of slow labours to stimulate the uterus into contracting, but not all labouring women respond to it.

... the test should help doctors establish which women may go on to deliver vaginally, as low levels of lactic acid suggest the uterus could still produce the contractions needed to push out the baby.

"But a high level of lactic acid in the amniotic fluid indicates that the uterus is exhausted. To stimulate this kind of labour with an oxytocin infusion would be like asking a marathon runner to run an extra 10,000 metres after he or she has passed the finish line."

He says the system of testing, which has already started in hospitals in Sweden, Norway and Belgium, should reduce the number of Caesareans for women who may not need them and accelerate them for those that do to "avoid the risk of complications from a long birth and limit unnecessary suffering" ...

What is not considered here is the option to rest a tired woman - and then let nature re-commence the labour when the mother and baby are well-rested. There is no questioning of the idea that once labour commences, it must accelerate and lead to the birth of the baby and placenta within a certain time frame. For many reasons, some women will pause in their labours. It might be that they're tired, hungry, bub isn't in an optimal position, or a uterus that has worked hard and needs a rest. Resting, re-fuelling and waiting for nature to take its course - provided all is well with the baby - is a reasonable approach to a labour that is progressing slowly. I doubt that this test will reduce caesarean rates; rather I fear it will increase the caesarean rates.

Melissa Maimann, Essential Birth Consulting 0400 418 448