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Hi, Not sure my contribution here is going to help with the original problem but as this is an issue I have been particularly intrigued by of late I was interested to sound out peoples opinions. While I can see that there is some appeal in stretching the boundaries of the latent phase, not least because it suspends the intensive surveillance associated with established labour, I fear that such a move would be potentially problematic in the current cultural climate where midwifery care is routinely withdrawn from those women who have been categorised as being in the latent phase. Which begs an interesting question: What is midwifery care? another thought: Is there only one latent phase? Mandie Scamell Centre for Health Service Studies University of Kent On 30 Jul 2010, at 16:31, Denis Walsh wrote: > 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