Minimum dilation rate - page 2

We are looking at our policies and am wondering what your minimum acceptable dilation rate in active labour is before resorting to ARM or oxytocin infusion? We are trying to get ours dropped to 0.5cm... Read More

  1. by   OzMW
    Quote from arwen_u
    i remember reading in peggy vincent's book babycatcher about a primip labor that lasted something like 3 days and everybody was just fine. i realize that's an anecdote, but get enough anecdotes and then you've got statistics.....
    stories are fab arwen, they are what makes us think about all the stuff we've been fed over the years! the obstetric myths as i call them!! then we can go looking for the stats to back up our new way of thinking.
    i heard a story of a local hb midwife looking after a primip. she got to fully dilated and then contractions stopped. so they all went to bed, slept all night (baby had been fine of course). woke up the next morning all refreshed and went on to push out a lovley 10 pounder!
    i also know a midwfe who used to work in a birth centre, if they stopped contracting and baby was well, no transfer, no augmentation if the woman didn't want it. tucked them in bed for a sleep!!!!
    heres the other studies:

    am j obstet gynecol. 2002 oct;187(4):824-8.
    reassessing the labor curve in nulliparous women.

    zhang j, troendle jf, yancey mk.
    objectives: our purpose was to examine the pattern of labor progression in nulliparous parturients in contemporary obstetric practice. study design: we extracted detailed labor data from 1329 nulliparous parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor. cesarean deliveries were excluded. we used a repeated-measures regression with a 10th-order polynomial function to discover the average labor curve under contemporary practice. with use of an interval-censored regression with a log normal distribution, we also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor, and the duration of labor for fetal descent at various stations. results: our average labor curve differs markedly from the friedman curve. the cervix dilated substantially slower in the active phase. it took approximately 5.5 hours from 4 cm to 10 cm, compared with 2.5 hours under the friedman curve. we observed no deceleration phase. before 7 cm, no perceivable change in cervical dilation for more than 2 hour was not uncommon. the 5th percentiles of rate of cervical dilation were all below 1 cm per hour. the 95th percentile of time interval for fetal descent from station +1/3 to +2/3 was 3 hours at the second stage. conclusion: our results suggest that the pattern of labor progression in contemporary practice differs significantly from the friedman curve. the diagnostic criteria for protraction and arrest disorders of labor may be too stringent in nulliparous women.

    [color=#00563f]obstetrics & gynecology 1996;87:355-359

    the length of active labor in normal pregnancies

    ll albers, m schiff, and jg gorwoda

    objective: to measure the length of active labor (first and second stages) in a low-risk population of non-hispanic white, hispanic, and american indian women, and to identify any differences among these ethnic populations. methods: descriptive statistics are presented for 1473 low-risk women at term who delivered at the university of new mexico hospital. data examined by ethnicity included demographics, intrapartum care and complications, and duration of the active-phase first stage (4 cm to complete cervical dilatation) and second stage (complete cervical dilatation to delivery) of labor. results: compared with friedman's criteria, 20% of these low-risk women had a prolonged active phase of the first stage, and 4% had a prolonged second stage, without excess maternal or infant morbidity. the mean length of active-phase, first-stage labor was 7.7 hours for nulliparas and 5.7 hours for multiparas (statistical limits 19.4 and 13.7 hours, respectively), with no differences according to ethnic group. the mean length of second stage was 53 minutes for nulliparas and 17 minutes for multiparas (statistical limits 147 and 57 minutes, respectively). american indian nulliparas had significantly shorter second stages than non-hispanic white women (p < .05). conclusion: active labor in healthy women lasted longer than is widely appreciated. upward revision of clinical expectations for the length of active labor is warranted
    Last edit by OzMW on Oct 2, '07 : Reason: Adding stuff
  2. by   cassioo
    We don't have any policy but what our doctors do which we all hate is bring them in and break water as soon as they can reach it (which on does at 1 cm) then pit and hope they deliver before 7pm...I work with a bunch men who should just work on an assemby line