Original Research Obstetrics| Volume 222, ISSUE 3, P267.e1-267.e9, March 2020

Contemporary patterns of labor in nulliparous and multiparous women

Published:September 28, 2019DOI:


      Controversy surrounds the definition of “normal” and “abnormal” labor.


      In this study, we used contemporary labor charts to explore labor patterns in large obstetric population (2011–2016).

      Study Design

      Detailed information from electronic medical records of live singleton deliveries at term (≥37 weeks of gestation) was extracted. Cases of elective cesarean deliveries, nonvertex presentation, and cesarean deliveries during the first stage of labor were excluded.


      Overall, 35,146 deliveries were included, of whom 15,948 deliveries (45.3%) were of nulliparous women. Median cervical dilation at admission was not significantly different between nulliparous (median, 4 cm; interquartile range, 3–5 cm) and multiparous women (median, 4 cm; interquartile range, 3–6 cm). In all, 99.3% of the women delivered vaginally. For nulliparous women, the median duration of the first stage of labor was 274 minutes (interquartile range, 145–441 minutes; 95th percentile, 747.5 minutes). Likewise, for multiparous women, the corresponding duration was 133 minutes (interquartile range, 56–244 minutes; 95th percentile, 494 minutes). During the latent phase (cervical dilation at admission, ≤4 cm), the time elapsed to the second stage of labor was 120–140 minutes longer in nulliparous women, whereas the gap between the groups decreased dramatically with advanced cervical dilation on admission. Nulliparous and multiparous women appeared to progress at a similar pace during the latent phase; however, after 5 cm, labor accelerated faster in multiparous women. Epidural anesthesia lengthens duration first and second stages of labor in all parities. Partograms according to cervical dilation at presentation are proposed.


      Cervical dilation rate is relatively constant between nulliparous and multiparous pregnant women during the latent phase. Time interval of the first stage was far slower than previously described, which allowed labor to continue for a longer period during this stage. These findings may reduce the rate of intrapartum iatrogenic interventions.

      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 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


        • Friedman E.A.
        Primigravid labor: a graphicostatistical analysis.
        Obstet Gynecol. 1955; 6: 567-589
        • 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
      1. World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme.
        Lancet. 1994; 343: 1399-1404
        • Laughon S.K.
        • Branch D.W.
        • Beaver J.
        • Zhang J.
        Changes in labor patterns over 50 years.
        Am J Obstet Gynecol. 2012; 206: 419.e1-419.e9
        • Ghosh R.E.
        • Berild J.D.
        • Sterrantino A.F.
        • Toledano M.B.
        • Hansell A.L.
        Birth weight trends in England and Wales (1986-2012): babies are getting heavier.
        Arch Dis Child Fetal Neonatal Ed. 2018; 103: F264-F270
        • Kominiarek M.A.
        • Zhang J.
        • Vanveldhuisen P.
        • Troendle J.
        • Beaver J.
        • Hibbard J.U.
        Contemporary labor patterns: the impact of maternal body mass index.
        Am J Obstet Gynecol. 2011; 205: 244.e1-244.e8
        • Shmueli A.
        • Salman L.
        • Orbach-Zinger S.
        • et al.
        The impact of epidural analgesia on the duration of the second stage of labor.
        Birth. 2018; 45: 377-384
        • Cheng Y.W.
        • Shaffer B.L.
        • Nicholson J.M.
        • Caughey A.B.
        Second stage of labor and epidural use: a larger effect than previously suggested.
        Obstet Gynecol. 2014; 123: 527-535
        • Hirshberg A.
        • Levine L.D.
        • Srinivas S.
        Labor length among overweight and obese women undergoing induction of labor.
        J Matern Fetal Neonatal Med. 2014; 27: 1771-1775
        • Friedman E.A.
        Labor in multiparas; a graphicostatistical analysis.
        Obstet Gynecol. 1956; 8: 691-703
        • Van Buuren S.
        • Groothuis-Oudshoorn K.
        MICE: multivariate imputation by chained equations in R.
        J Stat Softw. 2011; 45: 1-67
        • 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
        • Shi Q.
        • Tan X.Q.
        • Liu X.R.
        • Tian X.B.
        • Qi H.B.
        Labour patterns in Chinese women in Chongqing.
        BJOG. 2016; 123: 57-63
        • Oladapo O.T.
        • Diaz V.
        • Bonet M.
        • et al.
        Cervical dilatation patterns of “low-risk” women with spontaneous labour and normal perinatal outcomes: a systematic review.
        BJOG. 2018; 125: 944-954
        • Caughey A.B.
        • Cahill A.G.
        • Guise J.M.
        • Rouse D.J.
        • American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine
        Safe prevention of the primary cesarean delivery.
        Am J Obstet Gynecol. 2014; 210: 179-193
        • Zhang J.
        • Troendle J.F.
        • Yancey M.K.
        Reassessing the labor curve in nulliparous women.
        Am J Obstet Gynecol. 2002; 187: 824-828
        • 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
        • Liu E.H.
        • Sia A.T.
        Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review.
        BMJ. 2004; 328: 1410
        • Sng B.L.
        • Leong W.L.
        • Zeng Y.
        • et al.
        Early versus late initiation of epidural analgesia for labour.
        Cochrane Database Syst Rev. 2014; 10: CD007238
        • Anim-Somuah M.
        • Smyth R.M.
        • Cyna A.M.
        • Cuthbert A.
        Epidural versus non-epidural or no analgesia for pain management in labour.
        Cochrane Database Syst Rev. 2018; 5: CD000331
        • Anim-Somuah M.
        • Smyth R.M.
        • Jones L.
        Epidural versus non-epidural or no analgesia in labour.
        Cochrane Database Syst Rev. 2011; 12: CD000331
        • American College of Obstetrics and Gynecology Committee on Practice Bulletins-Obstetrics
        ACOG Practice Bulletin No. 49, December 2003: Dystocia and augmentation of labor.
        Obstet Gynecol. 2003; 102: 1445-1454
        • Hawkins J.L.
        Epidural analgesia for labor and delivery.
        N Engl J Med. 2010; 362: 1503-1510

      Linked Article