Reevaluation of Friedman’s Labor Curve: A Pilot Study
Sandra K. Cesario
Objective: To reevaluate the average length of each phase/stage of labor for multiparous andprimiparous women in North America who received no regional anesthesia or oxytocin augmentation or induction, to describe a range of labor lengths associated with good childbirth outcomes, and to determine ifthere is a consensus among labor and delivery nurse managers responding to the survey regarding the need to revise Friedman’s Labor Curve. Design: This pilot study used a descriptive and anonymouscross-sectional survey design. Surveys were mailed to 500 maternity care agencies in the United States, Canada, and Mexico with a return rate of 17.8% (n = 89). Each participating agency was asked tosubmit five patient cases to be included in the analysis. Sample and Setting: The sample of patient cases (n = 419) was drawn from randomly selected maternity care agencies throughout North Americarepresenting all sizes of agencies and geographic locations. The cases submitted for analysis represented women 14 to 44 years of age with varying ethnicities who received no regional anesthesia oroxytocin augmentation or induction. Twenty-three percent of the women in the sample (n = 97) were primigravidas. Results: The average length of labor for primiparous and multiparous women today is similar tothe average length of labor described by Friedman in 1954. However, a wider range of “normal” was found in cases included in the current study. Primiparous women remained in the first stage of laborfor up to 26 hours and the second stage of labor up to 8 hours with no adverse effects to mother or infant. Multiparous women remained in the first stage of labor
for up to 23 hours and the secondstage of labor for up to 4.5 hours with good birth outcomes. In addition, 87.6% of nurse managers responding to the survey believed that Friedman’s Labor Curve should be revised to meet the needs of...