For roughly 60 years, doctors have been following "The Friedman Curve" to monitor childbirth progression — a set of rules and stages for labor that includes the "one centimeter per hour" rule for dilation. However, a recent study found that dilation progresses much more slowly and, yes, labor can last a really long time for some women. But perhaps most importantly, the researchers also found that slow labor is not necessarily unhealthy if both mom and baby are otherwise doing well.
The Friedman Curve is still commonly used in hospitals and taught in medical schools, according to HuffPost. Despite the acceptance of its concepts, it looks like ole' Emanuel Friedman might have been a bit off when it comes to duration of childbirth. A recent study, published in PLOS Medicine, found that healthy labor can progress at varying rates from woman to woman, and dilation is actually a pretty slow process.
Lead researcher for the study Olufemi Oladapo, a medical officer at the World Health Organization, and his team looked at the births of 5,550 women from 13 hospitals in Nigeria and Uganda, all of whom had normal, low-risk pregnancies, went into labor naturally with babies positioned head first, and went on to deliver naturally, according to Scary Mommy.
When researchers examined the mothers' dilation progression, they found that it tended to take more than an hour for 1 centimeter dilation. In fact, dilation was "slow" for them, until they reached around 5 centimeters dilation — at that point, they dilated more rapidly. Overall labor times were varied; some first-time mothers dilated to 5 centimeters in several hours, but others took a lot longer. Oladapo explained to HuffPost that this is all natural:
Cervical dilatation progression during active labour is not linear. The rate of progression varies from one woman to another and women tend to enter their phase of natural labour acceleration at different times.
While this is likely not surprising to those of you who realize that women are not birthing robots, the findings of this study are important. Labor progressing "too slowly" is often used as justification for intervention during childbirth, sometimes leading to unnecessary C-sections, according to Scary Mommy. The American College of Obstetricians and Gynecologists (ACOG) reported that one in three births results in a C-section today, a number that has been creeping up over the past 15 years. What's more, "slow labor" is listed as the top reason for first-time moms receiving C-sections, according to the ACOG.
As important as C-sections are when necessary, they come with a list of risks and complications that may not be worth chancing just because your body is not abiding to The Friedman Curve and is taking things a little more slowly. There are a number of other factors — such as healthy vital signs for both mother and baby and the baby's head descending — that indicate that intervention is unnecessary, as Olapado explained to HuffPost.
Along with re-examining dilation rates, the ACOG is also leaning towards less intervention overall when it comes to low-risk mothers (which it defines as women without complications during the prenatal period, who are full-term, and have gone into spontaneous labor). Rather than have doctors watch these women with proverbial hawk eyes, the committee recommends that low-risk mothers stay home in the early stages of labor, and not be admitted to the hospital until they are 4 to 5 centimeters dilated.
Jeffrey L. Ecker, M.D., the Committee Opinion author issued a statement on the ACOG website that provides more information on how this impacts care providers:
These new recommendations offer providers an opportunity to reexamine the necessity of obstetric practices that may have uncertain benefit among low-risk women. When appropriate, providers are encouraged to consider using low-intervention approaches that have been associated with healthy outcomes and may increase a woman’s satisfaction with her birth experience.
The recommendations extend to the expectant mothers' hospital stays as well. Ecker recommends that the women not have continual fetal monitoring unless necessary, should be free to labor and push in the position of their choosing, and should not have their waters artificially broken if labor is progressing normally. There are also recommendations including emotional support professionals, such as labor coaches and doulas, epidurals, and water immersion as well.
It looks like the ACOG is leaning towards trusting the birthing process — and women's bodies — a little more, which sounds like a good thing to me. Every birth is unique and each woman's needs are different, but hopefully this more introspective trend of pregnancy body autonomy catches on in hospitals across the United States.
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