Birth Challenges, Physiologic Labor

A labor curve is NOT a labor management policy

Reading through the table of contents for the latest Journal of Midwifery, this commentary on changing the definitions for progress in labor caught my eye.1  It has me conflicted.

On the one hand I applaud the movement to change the standards of progress in labor. We’ve improved statistical techniques which allows us a better understanding of what is and is not normal. Epidemiological evidence shows that “failure to progress” is related to our rise in primary cesarean delivery in the United States.2

But on the other hand, I agree we need to test before we implement so we understand how to best “practice” with new information.  This is an area of science called implementation research, and it is key to ensuring our best intentions don’t end up with bad results. It helps prevent nurses and midwives from spending months changing a program only to find out it didn’t have the expected effect in their setting or their population.  It prevents us from writing policies with vague definitions like “low risk women” that may be interpreted differently by different providers.

I can sympathize with the commenters because it is my main complaint with the push for implementing the new obstetric levels of care, and my work on water birth has taught me that little research has been done on identifying the best policies and protocols; a reason I believe hydrotherapy is offered to such a small percentage of laboring women in the United States.  I understand the commenters complaint is not that we have not successfully identified a problem with our labor curve, but that if we just assume you can drop this new labor curve into the existing practice structure (that was built on incorrect assumptions of labor progress) we are making a big mistake.

What do you think?

Cohen WR, Sumersille M, Friedman EA. Management of Labor: Are the New Guidelines Justified? J. 2018;63(1):10-13. doi:10.1111/jmwh.12712
Boyle A, Reddy UM, Landy HJ, Huang C-C, Driggers RW, Laughon SK. Primary Cesarean Delivery in the United States. O. 2013;122(1):33-40. doi:10.1097/aog.0b013e3182952242
Jennifer (Author)