Back in the 1950’s, an obstetrician named Emanuel Friedman came up with a graph called “The Friedman Curve,” which depicted how childbirth was supposed to work. He divided the event into stages, estimating how long each stage should take. He also came up with rules about how frequent contractions should happen, and how quickly the cervix should dilate and efface.
Friedman’s concepts are still in wide use today—most notably the “one centimeter per hour,” rule about dilation. It’s still taught in medical schools, and used by most doctors, according to a recent article in the Huffington Post. And you can bet that almost all of us moms were probably taught that concept in a childbirth class, if we took one.
I don’t know about you, but my body didn’t get Friedman’s memo, and while I was lucky enough to have two healthy vaginal births, I progressed at my own weird rate, taking my sweet time dilating for the first many hours. Then, BOOM, I rapidly progressed through labor in one “I’m-about-to-die-and-murder-everyone-in-my-path” hour right before my babies were born.
That was just me, of course. All women are different. But that’s the point: it seems kind of bananas to assume that labor and childbirth should look one way for every woman. I think we all know at least one woman who was told she wasn’t progressing “fast enough” (according to the 1 centimeter per hour estimate, for example) and then found herself rushed into what seemed like an unnecessary intervention, even though her baby was doing well and she wasn’t having any other issues.
Thankfully, it’s 2018, not 1950, and a new study has hit the press that challenges all the rigid rules put forth by Dr. Friedman (sorry, dude, but your time is up). The study, published in the January issue of PLOS Medicine, found that labor can progress at varying rates for different women, and still be healthy. Specifically, they found that dilation often happens at a much slower rate than previously thought.
The research was led by Olufemi Oladapo, a medical officer at the World Health Organization. Oladapo and his team studied the births of 5,550 laboring women from 13 hospitals in Nigeria and Uganda. All the woman had normal, low-risk pregnancies and had gone into labor naturally. Their babies were positioned head-first, and went on be delivered vaginally.
When the researchers zeroed in on these mothers’ dilation, they found that it usually took more than an hour for them to dilate one centimeter. On average, dilation was “slow” for these moms, until they reached five centimeters, when the pace began to pick up. And, of course, overall labor times varied widely, with some first-time moms dilating to five centimeters within just a few hours, and others taking much longer.
Duh, right? Women’s bodies aren’t machines. We do our thing at our own rate. But I guess a study needed to come out to tell this to the world, like women haven’t been saying this since the dawn of time.
“Cervical dilatation progression during active labour is not linear,” Oladapo told the Huffington Post. “The rate of progression varies from one woman to another and women tend to enter their phase of natural labour acceleration at different times.”
Oladapo listed several signs to keep in mind when accessing if labor is going well—and dilation time isn’t the most important one. As long as a baby and mom’s vital signs are healthy, and the baby’s head descends, there should be no reason to intervene, he concluded.
This study is important because it could give us women a little more autonomy over our bodies and our experience as we give birth. But if implemented, it could also potentially decrease many unnecessary interventions, the most notable being potentially avoidable C-sections.
As the American College of Obstetricians and Gynecologists (ACOG) points out, one in three births result in a C-section these days, and that number has increased over the past 15 years. “Slow labor” is actually the top reason given for first-time moms’ C-sections. And while C-sections are of course life-saving and necessary at times, the rising rates of them are a concern.
Thankfully, this study is just one of several that have come out over the years warning that the proliferation of unnecessary interventions for low-risk birthing women is a real problem, and that we need to change the paradigm about what counts as a healthy labor and birth—trusting the process a little more and letting women’s bodies do their thing with less medical interference.
Let’s hope that doctors and other healthcare providers get the memo on this, and start to implement a more thoughtful, nuanced approach when it comes to how women give birth. It’s about time. Literally.
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