The prognosis for spontaneous labor in women with uncomplicated term pregnancies: Implications for cesarean delivery on maternal request

OBJECTIVE:: To assess the prognosis for vaginal delivery in women with entirely normal pregnancies who began spontaneous labor at term. METHODS:: Between January 1, 1988, and October 31, 2006, a total of 278,164 women delivered newborns at our hospital. A subset of women with uncomplicated pregnancies and spontaneous labor between 37 and 41 weeks of gestation then were identified for analysis of maternal and neonatal outcomes. The outcomes we studied included admission-to-delivery intervals, use of epidural analgesia, maternal perineal trauma, route of delivery, and several potential indices of neonatal condition at birth. RESULTS:: There were 103,526 (37%) women who delivered at our hospital during the study period who had normal term pregnancies and entered labor spontaneously. Overall, 96% of these women had vaginal deliveries, and adverse neonatal outcomes were rare. For example, perinatal deaths occurred in 0.3 of every 1,000 women. CONCLUSION:: Approximately one third of pregnant women have entirely normal pregnancies and enter spontaneous labor at term. Virtually all such women can anticipate safe vaginal deliveries for themselves and their infants.