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“Active Labor” Duration and Dilation Rates Among Low-Risk, Nulliparous Women With Spontaneous Labor Onset: A Systematic Review

Authors

  • Jeremy L. Neal CNM, RNC, PhD,

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    • Jeremy L. Neal, CNM, RNC, PhD, is an Assistant Professor in the College of Nursing, The Ohio State University, Columbus, OH.

  • Nancy K. Lowe CNM, PhD,

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    • Nancy K. Lowe, CNM, PhD, FACNM, FAAN, is Professor and Chair of the Division of Women, Children, and Family Health in the College of Nursing, University of Colorado Denver, Aurora, CO.

  • Karen L. Ahijevych RN, PhD,

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    • Karen L. Ahijevych, RN, PhD, FAAN, is a Professor and the Associate Dean for Academic Affairs in the College of Nursing, The Ohio State University, Columbus, OH.

  • Thelma E. Patrick RN, PhD,

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    • Thelma E. Patrick, RN, PhD, is an Associate Professor in the College of Nursing, The Ohio State University, Columbus, OH.

  • Lori A. Cabbage CNM, FNP, MSN,

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    • Lori A. Cabbage, CNM, FNP, MSN, is a clinical faculty member in the College of Nursing, The Ohio State University, Columbus, OH and is in clinical midwifery practice at Dublin Methodist Hospital, Dublin, OH.

  • Elizabeth J. Corwin RN, PhD

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    • Elizabeth J. Corwin, RN, PhD, is a Professor in the Division of Women, Children, and Family Health, College of Nursing, University of Colorado Denver, Aurora, CO.


College of Nursing, The Ohio State University, 1585 Neil Ave., Columbus, OH 43210-1289. E-mail: neal.167@osu.edu

Abstract

Introduction: Laboring women are often admitted to labor units under criteria that are commonly associated with the onset of active-phase labor (i.e., cervical dilatation of 3–5 cm in the presence of regular contractions). Beginning with these criteria through complete dilatation, this systematic review describes labor duration and cervical dilation rates among low-risk, nulliparous women with spontaneous labor onset.

Methods: Studies published in English (between 1990 and 2008) were identified via MEDLINE and CINAHL searches. Data were abstracted and weighted “active labor” durations (i.e., from 3–5 cm through complete dilatation) and linear dilation rates were calculated.

Results: Eighteen studies (n = 7009) reported mean “active labor” duration. The weighted mean duration was 6.0 hours, and the calculated dilation rate was 1.2 cm per hour. These findings closely parallel those found at the median. At the statistical limits, the weighted “active labor” duration was 13.4 hours (mean + 2 standard deviations) and the dilation rate was 0.6 cm per hour (mean − 2 standard deviations).

Discussion: These findings indicate that nulliparous women with spontaneous labor onset have longer “active” labors and therefore slower dilation rates than are traditionally associated with active labor when commonly used criteria are applied as the starting point. Revision of existing active labor expectations and/or criteria used to prospectively identify active phase onset is warranted.

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