WEDNESDAY, July 17, 2002 (HealthDayNews) -- Rush hour in the hospital delivery room may be just as dangerous as it is on the freeway.
Women giving birth to babies during the busiest times of the day in a hospital are more likely to experience severe vaginal tearing, according to a study in the new issue of the Journal of Epidemiology and Community Health.
Why?
Because of what the study authors call "convenience factors." During "high demand" times, doctors are more willing to use procedures to speed the delivery, they say.
"This adds to previous observations over the last few decades," says Dr. Salih Yasin, associate professor of obstetrics and gynecology at the University of Miami Jackson Memorial Hospital, the second largest hospital in the country. "I don't find [the results] to be unusual. This is a fact of life, whether we like it or we don't like it."
Yasin is referring to previous observations that, nationwide, more babies are born Monday to Friday than on weekends; more babies are born during "regular" (i.e. daytime and early evening) hours than "off" hours; and more Caesarean sections are performed during these so-called regular hours.
The current findings, though limited to the city of Philadelphia, are certainly in keeping with these earlier notations.
In this study, the researchers examined files pertaining to more than 37,000 deliveries in more than 25 hospitals in the City of Brotherly Love between 1994 and 1997.
About one-in-10 births involved the use of forceps or a vacuum, or both. Some 27 percent of the 19,000 spontaneous vaginal deliveries involved surgery to prevent tearing, and 31 percent involved the use of drugs.
The odds of intervention and of severe tearing (in the area between the exit of the birth canal and the anus) were markedly higher in the period between 10 a.m. and 10 p.m. than in the period between 2 a.m. and 8 am.
In those primetime hours, women were 43 percent more likely to have a delivery using an instrument, 10 percent more likely to have an episiotomy (an incision to enlarge the area where the baby exits), 86 percent more likely to be given drugs and 30 percent more likely to suffer severe tearing.
Forceps were used almost twice as often (12 percent of the time) for deliveries taking place between noon and 2 p.m., than for deliveries occurring between 2 a.m. and 4 a.m. (7 percent).
The study raises the issue that various interventions are not only unnecessary but risky.
"There are studies that show that there's often not seeming to be a medical justification for the obstetrical procedures that are performed," says David Webb, the study's lead author and director of research for ambulatory health services at the Philadelphia Department of Public Health. "There's a lot of unexplained variation, and often outcomes are not improved where the procedure rates are higher."
But it's not clear what should be done about the situation.
"The first question is how widespread this is in the U.S. and elsewhere. And, to the extent that it is widespread, the issues then are what are hospitals doing regarding monitoring and their own internal studies," Webb says.
There should be some response, though, Webb adds.
"To the extent that the disparities do exist, I would assume that they are addressable by looking at staffing arrangements and also developing policies that address variations that don't seem to have any explanation other than convenience or accident," he says.
What To Do
For information on all aspects of childbirth, visit Childbirth.org. For information on the importance of prenatal visits, check the American Academy of Pediatrics.
