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

 

 

Dear Maggie,