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
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,
Thanks a lot for that, it would be great!
Lucia
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 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?
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
