Labor

What do we know? How do we learn?

Written by Lorna Mazoff, CDM - April 2009

Labor-- A function of the female by which the products of conception (fetus, amniotic fluid, placenta, and membranes) are separated and expelled from the uterus through the vagina into the outside world.  Oxorn-Foote, Human Labor and Birth 5th edition

Recently, I conducted a very informal survey inquiring into the known/perceived lengths of labors in women who have been clients at our birth center.  I had many intentions in gathering this information, one of which was to write about it for this month’s newsletter.  It pleased me that the answers I gathered were more than descriptive and conveyed many different perceptions of labor.  It is my hope that this also spurred some conscious thoughts and discussions regarding labor and what women have experienced in this vast journey that can hardly be described by the common place definition found in most medical texts today (see above).
In our culture today we find it very important to be able to look at things closely, scientifically, so that we may better understand our bodies and our world.  In my studies as a midwife I have been very fortunate to have background in both the medical model and the midwifery model of childbearing.  Both are valuable, yet inherently different in many ways. 
In the medical world, labor is described as a graphic analysis, correlating the duration of labor with the rate of cervical dilation.  This graphical interpretation is known as Friedman’s curve (named after a man who invented the graph, of course).  Friedman’s curve graphs the latent and active phase of labor (0-10cm dilation).  There is room on this graph for: A-average multipara (women who has had more than 1 baby), B-average primigravida (woman who is having her 1st baby), C-secondary arrest of dilation (stuck at ~6cm), D-primary dysfunctional labor (long time getting from 2-10cm), E-prolonged latent phase (long time getting from 0-2cm).  Latent phase is 0-3cm dilation.  According to Friedman, the average latent phase in primigravidas is 8.6 hours, with the upper limit of normal at 20 hours.  For multiparas the figures are 5.3 and 14 hours.  In the primigravidas of Friedman’s series the average length of the active phase was 5.8 hours, and the upper limit of normal was 12 hours.  The rate of cervical dilation ranged from 1.2 to 6.8cm per hour.  A rate under 1.2cm per hour is considered “abnormal” and suggests “dysfunctional” labor.  In multiparas the average length of the active phase was 2.5 hours, with the upper normal limit at 6 hours.  A rate of cervical dilation less that 1.5cm per hour is “abnormal”. 
I don’t know about you, but the numbers (especially the decimal points), aside from being great in their range, quickly become overwhelming and are hardly helpful when one is really trying to understand the complexities, the intricate details and experiences that combine to form labor, solely through the utilization of this information.  My questions are: who were these women that were involved in this study that resulted in this graph? Where did they come from? What were their lives like? Did they have partner/family support? My list goes on and on, of course, and slowly settles to the complex conclusion that there is more that goes into a labor and how it progresses than can meet the eye (or graph paper).
But we like numbers, they can be validating in some ways.  What I have gathered from my own experiences and the information that was shared with me by the gracious women from whom I asked is that perceptions of labor oftentimes were shorter than the actual labor themselves--sometimes by a significant number of hours.  Women also used words like “[labor] felt indefinite”, “time stood still”, or “[time] passed in a blur”.  This was not always the case, of course, and some women were quite aware of the length of time being very significant and at times prolonged.  Many factors in a woman’s life contribute to the experience she will have in labor as well as her perception of that experience.  How complex is one’s life if she is to think back from the days of childhood, remember the chance meetings that resulted in relationships, the familial bonds which color her life even now, the experiences which spurred joy, doubt, fear, happiness, anxiety, love.  It is likely that a little bit of all of these life experiences may show up at one point or another during a profound life change such as pregnancy, childbirth and mothering.
Some of you may be reading this, trying to find where you may have fit in along the curve of Friedman. Perhaps you are remembering your own experience(s), counting hours or trying to perceive what was felt within those hours that were spent bringing forth your baby.  Many women may find they fit on the graph, many women will not.  Perhaps you are considering how long your upcoming labor will be, what those hours may hold for you, your baby and your family.  Do you find solace in a graph? Being a midwife, I strive always to maintain that which is normal and healthy within my scope of practice, my knowledge of the childbearing year.  I seek learning always from any source which I may find, midwifery texts, medical texts, articles, journals, birth stories.  I’ve found, though, that my greatest of teachers have been the women that I serve and their newborn babies.  Therefore, I encourage you to consider your own story and those of the women that surround you, for they hold countless volumes of knowledge, first hand.  It is from the women, the mothers, the babies, that you will learn the most.
Thank you for your time, your effort, and your wisdom.