The Long Wait

By Dr. Sanjay Gupta

It was 1 o'clock in the morning when my wife, 48 hours past her due date with our first child, gave my arm a sharp pinch. "The baby is coming," she whispered. She was in labor, and all the things we had talked about for 40 weeks and two days were happening all at once. Luckily, she had taken the time to make a birth plan, which forced us to discuss ahead of time such issues as pain management and what to do if her labor failed to progress. As we drove to the hospital a few hours later, that was our biggest concern.

Failure to progress is a medical term describing the situation in which the cervix--the opening of the uterus--is not dilating fast enough and the baby is not descending. By midnight the next night, 23 hours after that first pinch, my wife had barely progressed, although she was having contractions every five minutes. We asked three different doctors how slow was too slow, and we got three different answers. Every time her obstetrician performed an exam, she would shake her head and say nothing had really changed. My wife was worried that the doctors would start using the c-word (for caesarean section). She was tired and cranky, and worst of all for both of us, she was in pain.

The possibility of a lumbar epidural--a procedure that injects painkillers into the lower back--was addressed in my wife's birth plan, but she felt that her labor had not progressed far enough to consider one.

This is where it gets tricky. On the one hand, an epidural can relax the laboring uterus just enough to allow a woman to push harder and more efficiently without suffering too much pain. On the other hand, it can relax the muscles of the uterus to the point where contractions cease, causing progression to fail and increasing the likelihood of a caesarean. I'm a doctor, but I was struck by just how difficult this decision is for the patient--and her husband--as we sat there in the middle of the night conferring with her obstetrician.

It turns out we are not alone. In a survey of 303 women taken before they went into labor and published in Obstetrical and Gynecological Survey, one-fourth fully expected to have an epidural and an additional 40% thought one would be likely. About a third, however, wanted to avoid the epidural, and 7% said they would never have one under any circumstances. As it turned out, however, nearly 8 out of 10 women in this study ended up having an epidural, including nearly half the women who said they would never have one.

In our case, we waited another hour without any progress before deciding to undergo the 12-min. procedure. My wife felt immediate relief. Her uterus kept contracting, and with the help of a little Pitocin, a medication to speed up labor, we were in business. She was able to get some rest without pain while her body continued to push the baby down and open up her cervix. Less than three hours later, her doctor gave us the news we had been waiting to hear: we were ready to have a baby. My wife pushed hard, feeling pressure but no pain, and 21 minutes later, our baby girl, Sage Ayla, was born.

We learned that night that there are no magic answers when dealing with labor and failure to progress. The most important things are talking about your concerns and maintaining an open dialogue with your doctor and labor nurse. And I can attest firsthand that no matter how you get there, it is magical at the end.

Sanjay Gupta is a neurosurgeon and CNN medical correspondent