Lucia, Two recent papers suggesting the active phase of labour may not start until 5cm in some multips and 6cm in nullips are relevant to current care in latent phase. What is the Slowest-Yet-Normal Cervical Dilation Rate Among Nulliparous Women With Spontaneous Labor Onset? Jeremy L. Neal, Nancy K. Lowe, Thelma E. Patrick, Lori A. Cabbage, and Elizabeth J. Corwin Correspondence Jeremy L. Neal, 1585 Neil Avenue, Columbus, OH 43210-1289 [log in to unmask] Keywords pregnancy parturition labor obstetric labor onset labor stage first ABSTRACT Objective: To integrate research literature that has provided insights into the cervical dilation rate that may best describe the slowest-yet-normal dilation rate among nulliparous women when beginning with criteria commonly associated with active labor onset. Data Sources: A literature search from 1950 through 2008 was conducted using the Medline electronic database, reference lists from identified articles, and other key references. Study Selection: Research reports written in English with a focus on the cervical dilation and/or labor duration of lowrisk, nulliparous women with spontaneous labor onset. Data Extraction: Classic and contemporary research literature was reviewed and organized under the following subheadings: Friedman Studies, Partograph Studies, Active Management of Labor Studies, Additional Studies. Data Synthesis: An integrative review of the literature approximated the slowest-yet-normal cervical dilation rate for nulliparous women when beginning with criteria commonly associated with active labor. Conclusions: The slowest-yet-normal linear dilation rate approximates 0.5 cm/hour for low-risk, nulliparous women with spontaneous labor onset when starting at dilatations traditionally associated with active labor onset. However, this linear rate must be evaluated judiciously in light of the physiological acceleration of dilation that occurs during typical labor. Given this, cervical dilation for this population is likely slower than 0.5 cm/hour in earlier active labor and faster in more advanced active labor. Faster dilation expectations (e.g., 1 cm/hour) likely contribute to an overdiagnosis of dystocia (''slow, abnormal progression of labor'') in contemporary practice and, subsequently, to an overuse of interventions aimed at accelerating labor progress. JOGNN, 39, 361-369; 2010. Obstetrics & Gynecology: July 2010 - Volume 116 - Issue 1 - p 193 doi: 10.1097/AOG.0b013e3181e5b086 Departments: Letters to the Editor The Natural History of the Normal First Stage of Labor Zimerman, Ariel L. MD, PhD (cand.); Smolin, Ana MD Best wishes, Denis Dr Denis Walsh Associate Professor in Midwifery University of Nottingham Post Graduate Centre City Hospital Nottingham Hucknall Rd Nottingham NG5 1PB Tel: 0115 8231926 Mob: 07905735777 From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of LUCIA ROCCA Sent: 30 July 2010 15:54 To: [log in to unmask] Subject: Re: latent phase Dear Maggie, Thanks a lot for that, it would be great! Kind regards Lucia 2010/7/30 Hunter, Billie <[log in to unmask]> Hi Lucia Professor Billie Hunter has passed your email to me, I don't know what sort of guidelines to have for the latent phase but based on the research from the SELAN trial (Hodnett et al 2008) I have developed a Care Bundle for the latent phase. The care bundle is very women driven and centred and is based around support, coping mechanisms, non-pharmacological pain relief, optimal fetal positioning rather than times of observations, and ve's etc. Would you like me to send you a copy? Best Wishes Maggie Davies Consultant midwife 01639862568 07811558843 From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of LUCIA ROCCA Sent: 30 July 2010 10:52 To: [log in to unmask] Subject: latent phase Hello, I am in the process of updating hospital guidelines about latent phase of labour and running desperately late...... Does anyone have tips, recent research or guidelines to look at for inspiration? Thanks Lucia -- Lucia Rocca-Ihenacho 115 Greenwich South St London SE10 8NX 07989 230313 -- Lucia Rocca-Ihenacho 115 Greenwich South St London SE10 8NX 07989 230313