Purpose: To investigate the outcomes related to allowing a woman to labor for an additional 2 hours after 2 hours of “active phase arrest” instead of performing an immediate cesarean.
Method: A decision analytic model comparing an additional 2 hours of attempted labor versus an immediate cesarean birth for women in “labor arrest” (no cervical dilation for 2 hours while in active labor) was designed. Baseline assumptions were derived from the literature in terms of cost and morbidity and mortality of all modes of delivery, including recent data that suggest many women in 2 hours of active phase arrest will be able to achieve a vaginal birth if given additional time. We took into account the cost of prolonged labor, costs of each MOD, and cost of maternal mortality. The major morbidities we investigated were shoulder dystocia, Erb's palsy, facial nerve palsy, and maternal and neonatal death.
Result: Continuing to labor for 2 additional hours was cost-effective at a savings of $2,013 per delivery. It also resulted in 0.123 additional QALYs per delivery.
Conclusion: Allowing a woman who has been in active phase of labor arrest for 2 hours to continue to labor for an additional 2 hours is both cost-effective and predictive of better outcomes. This model suggests that standards of care that recommend an immediate cesarean delivery after 2 hours of active phase arrest may warrant a review. Table: Cost-effectiveness of continuing to labor after 2 hours of labor arrest
| Strategy | Cost | QALYs |
| Continue laboring | $ 9,101 | 56.666 |
| Cesarean delivery | $11,114 | 56.543 |
| Incremental Difference | $ 2,013 | 0.123 |
Candidate for the Lee B. Lusted Student Prize Competition