The tool– a tracking tool called a partograph– gives a more realistic expectation for how labor progresses in a first time mom so that doctors are less likely to see a slow early labor as a “failure to progress” and therefore less likely to intervene. Currently, hospitals conform to expectations for labor progress set by what’s called The Friedman Curve– a graph, developed some 50 years ago, that shows length of labor against centimeters dilated.
The curve shows that moms will dilate at about one centimeter per hour once in active labor. It’s pretty well established at this point that the expectation of dilating a cm per hour doesn’t make sense. According to the authors of this 2003 study, it’s more an ideal than an average.
One consequence of this standard, however, is that if a mom doesn’t meet it, she may be given labor induction hormones to speed things up. But what if she’s just having a perfectly normal slow period in her labor? And now she has medication that requires monitoring and brings with it an increased risk of c-section? Up to 50% of first time moms receive pitocin to speed up labor.
These researchers are basically saying, let’s use more realistic expectations for how labor should progress and then we won’t interfere so much. Apparently this new tracking tool more accurately matches the reality that dilation isn’t a linear process.
“A diagnosis of abnormally slow labor is the No. 1 reason that C-sections are performed in low-risk births by first-time moms…The researchers, lead author Jeremy Neal of Ohio State University and co-author Nancy Lowe of the University of Colorado Denver, hope their partograph could be computerized or designed as a smartphone application… Neal and Lowe predict that if their partograph were adopted widely in the United States, dystocia [slow or obstructed labor] diagnoses would be limited to only the slowest 10 percent of first-stage labors; oxytocin interventions would drop by more than 50 percent; and cesarean sections performed because of dystocia would decrease by more than 50 percent. Currently, more than a quarter of births by low-risk, first-time mothers result in cesarean section.
‘Dystocia is known to be over-diagnosed, which leads to unnecessary intervention, including cesareans,’ said Neal, an assistant professor of nursing at Ohio State. ‘We can tackle this issue by giving dystocia a clinically meaningful definition. This would go a long way toward preventing unnecessary cesareans for first-time moms which would, in turn, increase their chances of having successful labors and vaginal births for second, third and fourth deliveries as well.’” – from Science News online.
The next step for Neal and Lowe is to lead a pilot study of their partograph to judge its effectiveness.
Here’s the quote from Neal that perhaps best sums up their line of inquiry:
“Clinging to defunct dilation expectations leads to unnecessary interventions during labor.”
I’d be very curious to see this partograph. I think it could be a useful tool and may even change ideas about what constitutes “normal” progress in a first time birth in a way that would benefit moms and babies tremendously.