is there evidence for fast births= lack of complications

[mwherbs]

this is my question -- is there evidence that supports the idea that a fast birth is less likely to have complications?
I have said this to my own clients in the past but I don't know if I look over what I have seen- this is not true- so is it just my experience or what does the evidence show?

[bryonyvaughn]

Originally Posted by mwherbs

this is my question -- is there evidence that supports the idea that a fast birth is less likely to have complications?
I have said this to my own clients in the past but I don't know if I look over what I have seen- this is not true- so is it just my experience or what does the evidence show?

I'm not a MW and really don't know *but* I've been told my history of extremely precipitous labors is linked with uterine exhaustion and PPH. I have no idea if that's true in my case as my only uterine exhaustion was in my only induced and only non-precipitous labor *and* I used to bleed easily for all sorts of dumb things throughout my life. It might be worth reflecting on and seeing if you can note a trend in your cases though.

I did have a 7m posterior labor where the baby managed to rotate to lateral as the shoulders were born simultaneously. As the only option was my tailbone breaking or my pubic symphasis splitting, I'm glad my PS split. Tomorrow it will be six years and four pregnancies later and it's a very stable joint for me. I *assume* if I had even a 10 minute labor it would have given enough time for the baby to have rotated more fully or at least birth one shoulder at a time. That being said, PS split certainly isn't a bad complication. With all the endorphins in my system I didn't notice it at the time... just felt shooting pains up my legs a few days after the birth whenever I was walking and my heels would hit the ground. Also made for very careful sex positioning in the ensuing months. (Knees splayed cause torque on PS joint.)

~BV

[MsBlack]

I would like to see whatever there is on this. My experience has been that the fast births are the easy and totally straightforward ones, and this is what I tell clients who ask 'what if you don't make it here in time?'. Of course, I do not give any guarantees--do point out that we can never know until we are there, but that my EXPERIENCE is, the fast births are the ones where everything is working perfectly, and quite efficiently (and that I'll be available by phone in the car, should they birth without me, to help them determine how all is going and whether they should call 911)

[AlpineMama]

Only have a personal anecdote. My first birth was pretty fast and there were no real complications... I mean, I did have compound presentation, back labor, nuchal cord, and a bit of a stuck baby, but overall... I would say it was quite an easy ride. If that makes any sense. There was never a sense of "oh, what do we do now?" It was just a matter of getting on with it. And I don't think the position is any sort of a complication, just a variation on the standard. I recovered very quickly and didn't have a lot of bleeding. I was very tired but only after I gave birth; I had plenty of hormones to keep me high while pushing.

[sevenkids]

There are always exceptions to the rule, of course, but a fast labour in a healthy, term mother usually means baby is in a good position, contractions are efficient, and baby got plenty of room, the good ol' 3 P's rule. Can't get much more straightforward than that. Some of those fast-entry babies are a little stunned and look around like "What the......?" and take a little longer to realize they really have been born, and are sometimes quite bruised. Sometimes multips tend to dilate slowly over the last few weeks, and can get to 7 or 8 cm without really having noticable labour until transition kicks in.
I don't know about any evidence that will prove this true, only in my experience, fast labours are usually straighforward and uncomplicated. I imagine if you asked an ER doc in an inner city hospital or an EMT they'd say something different, as crack and cocaine users are prone to precip and abruption.

[Stacymom]

Originally Posted by sevenkids

Some of those fast-entry babies are a little stunned and look around like "What the......?" and take a little longer to realize they really have been born, and are sometimes quite bruised.

Hee-hee. I had a side of the freeway birth, and when my dd was born, my dh put her on my chest. She didn't cry or squeak or anything, but she was looking at me as if she wondered what in the world had just happened to her. I had forgotten about that! She wasn't bruised at all, and came out pink and breathing. And there was no head molding!

FTR, I had an extrememly fast labor, and a side of the freeway birth, and everything went relatively smoothly. I had extensive tearing, but I think that could have been prevented if I had had someone guiding me through the pushing phase. Although I did get to feel first hand what the fetal ejaculation reflex feels like!

[Meg_s]

first: 2.5 hours, PPH - but think that was because the placenta was GINORMOUS, tiny tear that didn't need stitching

second: 4 hours, cervical lip that the midwife had to help me with cause I was getting tired and had been "ready" for him to come all the way out for a couple of hours, much smaller placenta, not much blood, comparatively, tear that needed some stitching

[mendomidwife]

I have wondered the same thing and a few years ago briefly looked for any research but didn't find any.
I tell my patients this also....sometimes first timers are concerned that I won't make it - and I tell them that babies born in cabs and elevators are likely to be fine - that it is the long, drawn out labors that tend to be a problem.
I do think, however, that fast labors can be more difficult for the mother - the last time I rushed to a birth and the mother had already delivered I could tell that she was in shock - it was so fast.

Carla

[JaneSmith1010]

Again, posting by a non-med pro. I had a 3 1/2 hour birth with my first and had no complications whatsoever. I mean nothing during labor to worry us, no meconium staining, no back labor, no odd presentations, no chord situations, nothing. However, my son did experience a little water in his lungs which the doc (after transport for observation--I had a home birth) said was from not being compressed for long enough during labor..or something to that effect. Anyway, I am a Celiac and so I eat GF. I have read a book by one European OB saying that she does GF for many of her willing mothers in the last month or so of gestation b/c she's found that it is associated with faster, easier birthing. I guess the wheat or gluten congests the tissues, including that of the pelvis, and without this congestion birth is much quicker and easier. I don't know if she had anything other than her own patients to base this off of, any scientific data or not. This is a bit of a digression, I know. Sorry!

[Shelsi]

Originally Posted by sevenkids

Some of those fast-entry babies are a little stunned and look around like "What the......?" and take a little longer to realize they really have been born, and are sometimes quite bruised.

That's exactly how my dd STILL is lol. She actually came out screaming bloody murder so I'm sure she knew she was born but once she calmed down she had a bewildered look. She'll be 6 weeks tomorrow and still just looks around like "How did I get here??" Even strangers tell me she looks bewildered : She was a 4 hour start to finish labor with only 3 pushes, no real head molding and no bruising at all.

[philomom]

I had fast births with no complications.... but I'm just one mama.

[DoomaYula]

The most precipitous birth I've seen was a grand multip (7th) who warned me she had superfast labors. Hers was about 90 minutes from the first twinge til birth. She had very thick mec, but other than that, no problems for mom or baby.

The birth with the most complications I've seen was an incredibly long birth with an exhausted mom.

[wumanh]

I think the births are usually fine but baby may have meconium and bruising or take a bit to start breathing. It's the pph that may happen if the uterus is also in shock about how fast it emptied that I am on guard for.

[onlyboys]

My sis-in-law's first birth was about 4 hours from first twinge to baby, and she had zero issues at all. Just a skid mark, too.

I didn't even make it to her birth. Isn't that just perfect?

[junamoss]

it seems sometimes when they shoot out or turn and burn they need a little extra help. I had one that was blue and limp, nuchal cord x2, fht's in the sh** for the last minute. And it's the limpest baby I have ever seen. floppy, no tone. But i work in the hospital, so I watch those fht's. I love precips. I had this mom a couple of weeks ago, 2 hours from maybe having a contrx to delivery. In the hospital for 55 min. until del. She was a beautiful laborer.And it was her longest labor.
I haven't seen the PP hem. with the precip yet, but that makes sense.

[Ironica]

Originally Posted by jhow32000

Anyway, I am a Celiac and so I eat GF. I have read a book by one European OB saying that she does GF for many of her willing mothers in the last month or so of gestation b/c she's found that it is associated with faster, easier birthing. I guess the wheat or gluten congests the tissues, including that of the pelvis, and without this congestion birth is much quicker and easier. I don't know if she had anything other than her own patients to base this off of, any scientific data or not. This is a bit of a digression, I know. Sorry!

Well, that's encouraging... my son reacts to wheat, so we're both completely GF since we can't test him for celiac (we figured out the wheat reaction when he was 9 months old and still EBF). Maybe this birth will work better for us since I'm GF! ;-)

Again, not a birth professional here... but just the other day I found myself wondering if anyone has ever researched, or how you would design a study to determine, to what extent risk of c-section is a function of length of labor. I had just come home from a baby shower for a friend of my DH's who is very bright, well-educated, and yet is going into her birth COMPLETELY unprepared. :-/ She was shocked to find out that the nationwide c-section rate is almost 30%, and that it's HIGHER for people with her demographics (white, college-educated, upper-middle-class). I'm hoping she will decide to at least do some book learnin' before going in. (They're scheduled for the hospital birth class, and that's it... I pointed out that that class will teach her how the hospital wants her to birth.)

Anyway, I was really scared for her, especially since we went in so "prepared" (Bradley class, yadda yadda) and STILL had a c-section. But then I thought about my best friend, who basically did EXACTLY the same thing as this woman, but had a vaginal birth four months before my section. The difference? She went into active labor, and 7 hours later her baby was born (with an episiotomy and assistance from forceps due to decels, but anyway). Me, my water broke, and 18 hours later I STILL hadn't gone into labor, so I was induced, and 18 hours later I was totally stalled and got an epi, and 12 hours after THAT my uterus was conking out. I figure that if we'd waited for me to go into labor naturally (which we might have if I hadn't been GBS+, so we're trying to address that this time around), my son would have been born vaginally a few days later, but *shrug*.

It's common for people to sarcastically substitute the phrase "failure to wait" for the c-section diagnosis "failure to progress," which does imply that slow births are more likely to be c-sections... but how would you verify this? I'm thinking that, if you started off looking at c-sections that happened after a TOL, and binned them based on the number of hours of labor, you could develop a curve of probability of c-section based on hours in labor. Of course, you'd also want to compare that to the curve for labor leading to vaginal birth, to see if there's a handover at some point (i.e., vaginal births ramp up and peak until, say, 18 hours, then drop off while c-sections start to ramp up at 16 hours or something).

Which isn't the same as rate of complications, but c-section *is* kind of a complication ;-) so it's a related question.

[MsBlack]

Just missed my second fast labor in a row yesterday...both 2nd time moms. I have a 3rd second timer coming due any day now. And as second babies are statistically the 'fastest' babies, well, I guess I better hope this mom calls me early and then, I better get on the road ASAP. I only dallied 20min yesterday...only dallied at all cuz mom said "I'm in labor, but I think it'll be awhile, don't come yet". But I thought she was wrong, so I got ready anyway and waited for that second call, which came 20min after the first one.

Anyway, another fast labor to 'prove' that the fast ones--at or near term anyway--are generally the easy ones. The dad called me, clearly in a daze, when I was 12 min from their home. "We have the baby...it's out. What should we do now? Can you hear her, does she sound ok?" (baby yelling lustily in background--a blessed sound for this mw when I've missed one) "Breathe deep...how is Mama?" "uh, K--how are you doing?" (I hear her crowing in background "I'm GREAT!") "she says she's great...what should we do?" "Keep the baby close, comfort her next to mom's skin...I'll be right there. Hey S, Breathe, it's all good!" Dad breathes, and signs off sounding a bit less dazed.....one happy lil fam when I arrive, all is perfect and stays perfect. After a difficult and over managed first birth, Mom is on cloud 9, repeatedly saying things like "I'm a powerful LIONESS!" "I feel so VICTORIOUS"

But something just occurred to me, mwherbs--maybe there is no 'data'/studies on this phenomenon because no one has ever seen any problems with these short labors! No one has yet found a way to make it into something scarey....

I recall in early midwifery training, learning the words 'precipitous delivery', and learning that there MAY be an association with pph and/or baby start-up issues. Something about baby might have issues regarding too fast 2nd stage with too fast of a pressure change from in-yoni to out-of-yoni. Hmmm, potential for cerebral hemorrhage or something of that nature? Never have seen this--tho I have seen a few screamers born fast (more often than I've seen screamers who were born more slowly), but nothing that wasn't soon comforted on mama's belly/breast. No 'precips' who were slow to start, and no pph's. I think this idea of 'danger' in a precip is theoretical, and not at all borne out in reality.

So this discussion, along with my fairly high number of missed 'precips' in the last year, has made me rethink this. Now, I just don't even think I like this term 'precipitous delivery'. It makes it sound like a problem, or a potential problem, when clearly it's NOT. I need to find a new word for these fast mamas, the ones who may have some hours of easy early labor, but with or without that, they have but an hour or 3 or 'hard labor' and quick 2nd stages.

Anyway--again, maybe there is no 'evidence' because only 'problems' get studied--and these Highly Efficient Birthers just don't tend to have problems!

[mwherbs]

well I have been looking and will not comment much I really want evidence one way or another-- there is one study on fast second stage and high rate of brachial plexus injury--- the missed births that I could comment on would be almost the opposite of what you describe--with a few exceptions-- if we were to say that we have 5-10% complications - prolonged are transferred - worn out moms are transferred -- so what I see for the most part "average" length births much less incidence of hemorrhage or babies that need some help.

------ the other problems with precip births and looking at stats has already been stated- because the drug addicts also have this type of birth before they get to the hospital so they skew the stats/info on this--- if you remember the Pang study the non-planned home births altered the info and made for bad stats----

[MsBlack]

mwherbs--

I'm curious about your experience w/'missed births'. Were these all short labors, or were some labors where you were not notified soon enough? I do not assume anything as a 'rule' about fast birthers, but of course I do have the truth of my own experiences. In all cases, very healthy moms, all of them with 'proven' pelvis, a about 1/2 on their 4th baby or more, 1/2 on second baby. Only 1 with history of fast labor--but in that case, she wanted me to wait a bit, wasn't really sure this was it. Naturally I would rather be there than miss it--and do have some concern about missing a birth since I know there IS no rule about fast births (or any birth, really). And of course, I am on the phone w/fams--with one, I talked dad through catching, others called right after baby's emergence and then I talked them through some things to observe, things to do/avoid doing while waiting for me.

But also, in most cases we have talked quite a bit before labor about birth, catching, neonate, immediate pp time--I want parents prepared, and to know what I'm doing or asking for and why, or better yet to be able to manage on their own with my support, when the birth does happen. So, talking them through stuff is more of a reminder than a crash course--and they are not freaked out...rushing a bit, perhaps, but not freaked out.

As for fast second stages and brachial plexus injuries---hmmm. Can you post a link? I find myself wondering where these births took place, and 'managed' by whom--what external factors could have influenced outcomes.

[because]

Originally Posted by MsBlack

I recall in early midwifery training, learning the words 'precipitous delivery', and learning that there MAY be an association with pph and/or baby start-up issues.

This was my situation with DS. About 90 minutes from recognizable labor to holding the baby. .M/w missed it by 15 minutes. DS was very pale, limp, grunty. Then I had PPH and an emergency transport for the bleeding and retained placenta.