Journal of Obstetric, Gynecologic & Neonatal Nursing
IN REVIEWWhat is the Slowest-Yet-Normal Cervical Dilation Rate Among Nulliparous Women With Spontaneous Labor Onset?
Section snippets
Background
Clinical expectations of cervical dilation among nulliparous women continue to be heavily influenced by the research of Dr. Emanuel Friedman, which began more than a half-century ago. Additional knowledge about dilation rates during labor for this population can also be gleaned from the classic publications borne from two of the most widespread labor assessment/management strategies: the partograph and the active management of labor protocol. More contemporary work has also been done in this
Discussion
When beginning with criteria commonly associated with active labor onset (e.g., 3 to 5 cm and regular contractions), the extant research indicates that the slowest-yet-normal, linear dilation rate approximates 0.5 cm/hour for low-risk, nulliparous women with spontaneous labor onset. This rate is achievable for approximately 80% to 90% of this population. Commonly applied linear expectations such as 1 cm/hour are unrealistically fast.
Consideration must be given to two specific realities before a
Conclusion
Our review of the relevant extant research concludes that 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 includes the slower rate of earlier active labor and the physiological acceleration of dilation that is typical of advancing labor.
Conflict of Interest Disclosure
Nancy K. Lowe is the editor of JOGNN. She was excluded from the peer review and editorial decision for this article.
Acknowledgments
Initiated under a Ruth L. Kirschstein National Research Service Fellowship Award, National Institute of Nursing Research, NIH 1 F31 NR010054.
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Cited by (51)
Use of the partograph - Current thinking
2020, Best Practice and Research: Clinical Obstetrics and GynaecologyA qualitative meta-synthesis of women's experiences of labor dystocia
2020, Women and BirthFirst assessed cervical dilatation: is it associated with oxytocin augmentation during labour? A retrospective cohort study in a university hospital in Switzerland.
2020, MidwiferyCitation Excerpt :Midwives and obstetricians should be aware of this and allow women to be admitted to hospitals in the latent phase without intervening too early. Care providers may have lost their trust in physiological childbirth, as for example the use of oxytocin is more the rule than the exception (Neal et al., 2010). Our observation is that labour dystocia criteria should not be applied too early in order to reduce the use of oxytocin.
Evaluation of the implementation of a protocol for the restrictive use of oxytocin during spontaneous labor
2020, Journal of Gynecology Obstetrics and Human ReproductionOxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 1: Definition and characteristics of normal and abnormal labor
2017, Journal of Gynecology Obstetrics and Human ReproductionCitation Excerpt :Accordingly, for this section, when the studies do not specify the type of dystocia, we use the generic term “dystocia” to characterize a general defect or problem in rate of progress per centimeter of cervical dilation. As Neal et al. explained, the threshold of < 1.2 cm/h proposed by Friedman was based only on the stable phase (that is, the phase with the maximum slope), and not on the entire active phase (acceleration, stability, and deceleration phases) [4]. According to these studies, applying the median +2 SD for these three phases together appears to produce a threshold on the order of 0.6 cm/h. Neal et al. also calculated the mean dilation speed during the active phase for the populations studied by Albers et al. [1], Albers [22] and Jones et al. [23].