Using percentile matching to simulate labor progression and the effect of labor duration on birth complications

Of the nearly 4 million births that occur each year in the U.S., almost 1 in 3 is a cesarean delivery. Due to the various increased risks associated with cesarean sections (C-sections) and the potential major complications in subsequent pregnancies, a re-evaluation of the C-section rate has been a topic of major concern for patients and health care providers. To evaluate the current C-section rate due to a “failure-to-progress” diagnosis, we implement a percentile matching procedure to derive labor progression times needed to replicate the delivery process in a discrete event simulation for women undergoing a trial of labor. The goals are to: (1) model the natural progression of labor in absence of C-sections, (2) determine the underlying rules responsible for the current rate of cesarean deliveries due to a “failure-to-progress” diagnosis, and (3) develop stopping rules that reduce the number of cesarean deliveries and the rate of complications.