How many times has a student in your childbirth class reported that she had a cesarean delivery because, at 5 cm of dilation, labor stalled for 2 or 3 or even 4 hours? This could become a thing of the past if healthcare providers heed the advice of researchers from the NIH-supported Consortium on Safe Labor.
In a study published in the December edition of Obstetrics and Gynecology, researchers from the Consortium on Safe Labor found that normal labor may take more than 6 hours to progress from 4 cm to 5 cm and more than 3 hours to progress from 5 to 6 cm of dilation.
The Consortium for Safe Labor is a multicenter retrospective study that abstracted detailed labor and delivery information from electronic medical records in 19 hospitals across the United States. For this study, a total of 62,415 pregnant women were selected who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome. The study included both nulliparous and multiparous women; approximately half the women received oxytocin for labor augmentation; and about 80% received epidural analgesia. The majority of the women had a spontaneous vaginal birth. Surprisingly, researchers found that labor progress before 6 cm was similar for both nulliparous and multiparous women; only after 6 cm did labor progress faster for multiparous women.
Importantly, the researchers recommended that for our contemporary population, 6 cm rather than 4 cm may be a more appropriate landmark for the start of active labor. For both nulliparous and multiparous women, labor progressed at a much faster pace after 6 cm. The authors called for healthcare providers to allow labor to continue for a longer period before 6 cm in order to reduce intrapartum and subsequent repeat cesarean surgeries.
This study confirmed several earlier studies that also indicated that normal labor may take much longer than previously thought.
Important information for childbirth educators to know and to pass along to their students!
(Regarding patience: Thank you to our blog readers who have continued to check The Family Way blog over the last two months. Moving is hard work and very time-consuming! We plan to resume more frequent blog posts.)