Advertisement

Changes in labor patterns over 50 years

Published:March 12, 2012DOI:https://doi.org/10.1016/j.ajog.2012.03.003

      Objective

      The objective of the study was to examine differences in labor patterns in a modern cohort compared with the 1960s in the United States.

      Study Design

      Data from pregnancies at term, in spontaneous labor, with cephalic, singleton fetuses were compared between the Collaborative Perinatal Project (CPP, n = 39,491 delivering 1959-1966) and the Consortium on Safe Labor (CSL; n = 98,359 delivering 2002-2008).

      Results

      Compared with the CPP, women in the CSL were older (26.8 ± 6.0 vs 24.1 ± 6.0 years), heavier (body mass index 29.9 ± 5.0 vs 26.3 ± 4.1 kg/m2), had higher epidural (55% vs 4%) and oxytocin use (31% vs 12%), and cesarean delivery (12% vs 3%). First stage of labor in the CSL was longer by a median of 2.6 hours in nulliparas and 2.0 hours in multiparas, even after adjusting for maternal and pregnancy characteristics, suggesting that the prolonged labor is mostly due to changes in practice patterns.

      Conclusion

      Labor is longer in the modern obstetrical cohort. The benefit of extensive interventions needs further evaluation.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Friedman E.A.
        Primigravid labor; a graphicostatistical analysis.
        Obstet Gynecol. 1955; 6: 567-589
        • Friedman E.A.
        Labor in multiparas: a graphicostatistical analysis.
        Obstet Gynecol. 1956; 8: 691-703
        • Zhang J.
        • Troendle J.
        • Mikolajczyk R.
        • Sundaram R.
        • Beaver J.
        • Fraser W.
        The natural history of the normal first stage of labor.
        Obstet Gynecol. 2010; 115: 705-710
        • Zhang J.
        • Landy H.J.
        • Branch D.W.
        • et al.
        Contemporary patterns of spontaneous labor with normal neonatal outcomes.
        Obstet Gynecol. 2010; 116: 1281-1287
        • Zhang J.
        • Troendle J.
        • Reddy U.M.
        • et al.
        Contemporary cesarean delivery practice in the United States.
        Am J Obstet Gynecol. 2010; 203: 326.e1-326.e10
        • Treacy A.
        • Robson M.
        • O'Herlihy C.
        Dystocia increases with advancing maternal age.
        Am J Obstet Gynecol. 2006; 195: 760-763
        • Vahratian A.
        • Zhang J.
        • Troendle J.F.
        • Savitz D.A.
        • Siega-Riz A.M.
        Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women.
        Obstet Gynecol. 2004; 104: 943-951
        • Halpern S.H.
        • Leighton B.L.
        • Ohlsson A.
        • Barrett J.F.
        • Rice A.
        Effect of epidural vs parenteral opioid analgesia on the progress of labor: a meta-analysis.
        JAMA. 1998; 280: 2105-2110
      1. Osmundson SS, Ou-Yang RJ, Grobman WA. Elective induction compared with expectant management in nulliparous women with a favorable cervix. Obstet Gynecol116:601-5.

        • Niswander K.R.
        • Gordon M.
        The collaborative perinatal study of the National Institute of Neurological Diseases and Stroke: the women and their pregnancies.
        W. B. Saunders, Philadelphia, PA1972
        • Hardy J.B.
        The Collaborative Perinatal Project: lessons and legacy.
        Ann Epidemiol. 2003; 13: 303-311
        • Zhang J.
        • Troendle J.F.
        • Yancey M.K.
        Reassessing the labor curve in nulliparous women.
        Am J Obstet Gynecol. 2002; 187: 824-828
        • American College of Obstetrics and Gynecology
        ACOG practice bulletin no. 36.
        Obstet Gynecol. 2002; 100: 177-191
        • Rouse D.J.
        • Owen J.
        • Savage K.G.
        • Hauth J.C.
        Active phase labor arrest: revisiting the 2-hour minimum.
        Obstet Gynecol. 2001; 98: 550-554
        • Rouse D.J.
        • Owen J.
        • Hauth J.C.
        Active-phase labor arrest: oxytocin augmentation for at least 4 hours.
        Obstet Gynecol. 1999; 93: 323-328