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Simulation model of the relationship between cesarean section rates and labor duration
Karen T Hicklin1, Julie S Ivy2, James R Wilson3
1Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA. khicklin@email.unc.edu.
Health Care Management Science
|July 12, 2018
Summary
Cesarean delivery, the most common major surgery, can be reduced by allowing longer labor durations. Current labor progression rules may lead to unnecessary C-sections, impacting maternal health.
Area of Science:
- Obstetrics and Gynecology
- Medical Simulation
- Biostatistics
Background:
- Cesarean delivery is a prevalent major surgery globally, accounting for a significant portion of births in the US.
- Prolonged labor increases infection risk for patients requiring Cesarean delivery.
- Unnecessary Cesarean delivery can negatively affect a patient's future health outcomes.
Purpose of the Study:
- To model the natural progression of labor and analyze labor duration based on dilation state for various labor types.
- To evaluate the impact of the Friedman curve and other labor-progression rules on Cesarean delivery rates and maternal/fetal complications.
Main Methods:
- Development of two stochastic simulation models for the delivery process.
- Utilized a shifted lognormal distribution to model labor duration across dilation states and labor types.
- Employed a percentile-matching procedure using literature-reported quantiles for distribution parameter estimation.
Main Results:
- Simulation models suggest that labor durations exceeding two hours (Friedman curve's labor arrest time limit) should be permissible for nulliparous women without prior complications.
- Recommended that allowed labor duration should be contingent on the dilation state.
Conclusions:
- Current labor-progression guidelines may contribute to higher Cesarean delivery rates.
- Revising labor duration allowances based on dilation state could optimize delivery outcomes and reduce unnecessary Cesarean deliveries.
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