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I am loving this discussion! I teach the intrapartum course to midwifery students, and so many students struggle with how to make decisions on labor progress when there are no alternatives to Friedman criteria. Soo, your statement below about "making visible the invisible signs use to indicate how labor is progressing" is exactly what I would like to explore. I think it is signficant that, in addition to the invisble signs we look for as midwives, we also often feel the need to alter how we present this information in charting, etc. in order to allow women the opportunity to labor and birth without intervention. (I'm refering here to the discussion about not saying the woman in complete right away to prevent intervention after 2 hours). This is an enormously complex dance, in my opinion, that is very hard to teach to midwifery students. It is no wonder that more and more midwives (in the U.S. anyway) simply follow linear guidelines like Friedman's. If there is another student working on this I would love to contact her. Amy -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. on behalf of Soo Downe Sent: Mon 2/19/2007 10:41 AM To: [log in to unmask] Subject: Re: length of labour I agree Mavis - as I said in my last email, it is patterns of labour and familial tendencies that provide a much richer focus for understanding individual norms than averaged out linear progress, though the idea of the caseholding work is to get an understanding of a range of 'unusual normal'. Mechthild Gross has done some interesting work on labour patterns: Gross MM, Drobnic S, Keirse MJ. Influence of fixed and time-dependent factors on duration of normal first stage labor. Birth. 2005 Mar;32(1):27-33. Gross MM, Haunschild T, Stoexen T, Methner V, Guenter HH. Women's recognition of the spontaneous onset of labor. Birth. 2003 Dec;30(4):267-71. Mechthild, do you want to comment? Ultimately, we need to surface and make visible the invisible signs midwives use to indicate how labour is progressing, even when they are not using techniques of measurement, so that 'progress' can be deliniated by these signs, and not by linear measurements. Mavis, didnt you have a PhD student who was doing this? all the best soo >>> [log in to unmask] 02/19 12:31 pm >>> I am concerned about the somewhat mechanical concept of labour as a set event with standards regarding its length. All midwives, who work outside industrial-model labour wards, will have met women whose labours differ greatly and some of whose labours stop at any point in dilatation and start again. Or whose cervix contracts rather than dilates, Ina May uses a lovely Spanish word for this which I can't remember. There are pockets of midwifery knowledge around supporting women whose labours are so long or short that they are hard for them, or whose labour has stopped. What women feel differs greatly too, as does what it is socially acceptable to report feeling. We, as midwives, have a lot of influence here. I know you know this Chris, but I want to point out that there is something odd about measuring what is socially or medically constructed and then applying it to individuals. For most midwives, the tools used to measure length of labour are defined by their work setting and created by powerholders there. Midwives then quietly subvert this measurement to help their clients or themselves. By all means let us study the tools for measuring labour, but let's not accept them as affording absolute measurement. The tools so often decide the measurement. Best Wishes, Mavis Mavis Kirkham Professor of Midwifery Sheffield Hallam University 33 Collegiate Crescent Sheffield S10 2BJ tel 0114 2255644 From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Amy Marowitz Sent: 13 February 2007 14:34 To: [log in to unmask] Subject: length of labour I am very interested in this and hope to do my doctoral project on the topic, though am still the in early stages of formulating my question. There is a growing body of evidence refuting Friedman's criteria for prolonged labor. A few studies have been done on using the more relaxed criteria of 4 hours without progress for arrested labor (Friedman terminology) or the action line (I think this is Philpotts and Castle's terminology. I am thinking of exploring the following question: What criteria do American midwives use to define prolonged labor? I think there is huge variety here, and that duration is not the only criteria used by some (maybe many?) midwives. I'd be most interested in any comments from list members. Denis, what is your new book? I'd like to read the chapter on length of labor! Amy (doctoral student and midwifery faculty at Frontier School of Midwifery and Family Nursing) -----Original Message----- From: A forum for discussion on midwifery and reproductive health research. on behalf of Denis Walsh Sent: Tue 2/13/2007 3:05 AM To: [log in to unmask] Subject: Re: length of labour Hi Chris, Here are a few references on this. I have a chapter in my new book published in April on this and think I have accessed most of the papers. Albers L (1999) The duration of labour in healthy women. Journal of Perinatology 19(2):114-9 Bailit J, Dierker L, Blanchard M, Mercer B (2005) Outcomes of women presenting in active versus latent phase of spontaneous labour. Obstetrics & Gynaecology 105:77-79 Cardozo L, Gibb D, Studd J et al (1982) Predictive values of cervimetric labour patterns in primigravidae. British Journal of Obstetrics & Gynaecology 89:33-38 Cesario S (2004) Re-evaluation of Freidman's labour curve: a pilot study. Journal of Obstetrics, Gynaecology and Neonatal Nursing 33:713-722 Gurewitsch E, Diament P, Fong J et al (2002) The labour curve of the grand multipara: Does progress of labour continue to improve with additional childbearing? American Journal of Obstetrics & Gynaecology 186:1331-8 Lavender T, Alfirevic Z, Walkinshaw S (2006) Effects of different partogram action lines on birth outcomes: a randomised controlled trial. Obstetrics & Gynaecology, 108(2):295-302 Zhang J, Troendle J, Yancey M (2002) Reassessing the labour curve. American Journal Of Obstetrics & Gynaecology. 187:824-8. Best wishes, Denis Dr Denis Walsh Reader in Normal Birth, University of Central Lancashire Independent Midwifery Consultant Home address: 366 Hinckley Rd Leicester LE3 OUT, UK Mobile: 07905735777 ----- Original Message ----- From: "Chris McCourt" <[log in to unmask]> To: <[log in to unmask]> Sent: Monday, February 12, 2007 5:04 PM Subject: length of labour dear all I'm interested to know whether there is any written or research evidence on whether norms of the length of labour have changed in the recent past. I'm aware of the impact of Friedmans work on practices in labour wards, but am wondering whether there is anything to suggest further trends in what is seen as a 'normal' length of labour (and by association, whether this could be related, in either direction, to rising intervention rates) all ideas on relevant evidence sources, or personal/professional observations welcome Chris