Thursday, September 19, 2013

Friedman's Curve: An Outdated Standard?

This week's blog post explores the concept of "failure to progress" during labor and is based on a recent article at Evidence Based Birth. Please visit their website for more details and a full list of references.


C-Sections and Friedman's Curve

As most supporters of Lamaze childbirth preparation know, the C-section rate in the United States is among the highest in the world. About 30% of first time moms end up having C-sections, and about 35% of those C-sections were performed due to a diagnosis of "failure to progress."

Recent research, however, has shown that the standard measure of labor progress--Friedman's Curve--is outdated, and that following this standard may result in unnecessary interventions, including C-sections.  Friedman's Curve, published in 1955, describes the average length of time it took for women in Friedman's study to dilate each centimeter. Friedman found that the average time to get from 0-4cm dilation was 8.6 hours, the average length of time to get from 4-10 cm was 4.9 hours, and the average length of "pushing" was 1 hour. Friedman's data showed that labor sped up once women entered the active labor phase (about 4 cm) until they reached about 9cm dilation.Until recently, women whose labors did not follow Friedman's standards often had their labors induced or augmented (generally by use of pitocin).

Changes in Labor Since 1955

Although based on data from 500 first time mothers, labor conditions in 1955 were much different than today. In 1955 most women were moderately to heavily sedated during labor (Twilight Sleep was still common). Maternal demographics have changed greatly over the years as well, so today's moms are more likely to be older, overweight, etc .

In order to see whether Friedman's curve was still useful, a 2010 research study examined labor records from more than 62,000 women across the US. This study found that for women who go into labor on their own, labors tend to be much slower than in 1955. Most women do not start dilating rapidly at 3cm as Friedman had found, and many women went for long periods of time without any dilation. In and of themselves, today's longer labors have not been shown to generate increased risk of harm to baby or mother. However, if labor progress is measured by old standards, today's women are more at risk for medical interventions aimed at speeding up labor.

New Standards

In 2013 the definitions of normal labor and arrested labor were updated to reflect recent research. It is recognized that active labor may not begin until 6cm dilation, and the new definitions make it more difficult to diagnose arrested labor. It is hoped that these new definitions will decrease the rate of preventable C-sections.

The new standards make it more likely that families will be able to follow the Healthy Birth Practices promoted by Lamaze International, in particular Healthy Birth Practice 1: Let Labor Begin On Its Own and Healthy Birth Practice 4: Avoid Interventions that Are Not Medically Necessary. 
Most importantly, the new standards do a better job of recognizing that every woman is different, and that labor does not progress in the same way or at the same speed for everyone. Women's bodies are uniquely designed to undergo the process of pregnancy and labor, and in most cases can get the job done well without much intervention.



Thursday, September 12, 2013

A Great Resource for New Families



This week on the blog I would like to give a shout out to our friends over at Mara's World.
Mara's World is a relatively new website run by 3 individuals who are dedicated to helping new parents navigate the world of pregnancy and infanthood.

The website contains a number of articles and planning guides covering a range of topics related to pregnancy and parenting. Some of the topics include:

  • Pregnancy Nutrition
  • How to Find a Childbirth Class
  • How to Write a Birth Plan
  • Relationship and Sex After Pregnancy
  • How to Select a Pediatrician
  • Top 10 Ways to Avoid Sleep Deprivation With a Baby
I have read a number of the articles and have found that they present useful, unbiased information that hits home. We particularly like their article Do I Really Need to Take a Childbirth Class? The short answer is: probably! Check out their website when you have a chance! 


Thursday, September 5, 2013

Fall Partnership Classes for Babies and Toddlers

At Lamaze Family Center Ann Arbor we have several great partners who offer classes for babies and toddlers at our location. This week's blog will provide some information about the great classes offered by two of our partners, Kindermusik and Signing Smart. Both programs have free preview classes coming up in the next week so you can check them out!


Kindermusik offers two types of classes at Lamaze, Kindermusik Village for babies 0-18 months, and Kindermusik Our Time for toddlers 18 months-3.5 years.
At Kindermusik classes you will experience:

• Variety of music. Musical diversity builds strong neural networks in a baby’s forming mind, which is why each Kindermusik semester contains an array of styles, sounds, and genres.
 
• Instrument play. Age-appropriate experiences with child-safe instruments enhances a sense of rhythm and steady beat, develops a keen awareness of the distinguishing qualities of sound, and encourages spontaneity and creativity.

• Dance. A classroom full of baby and adult pairs dancing together helps a little body develop the muscle strength needed to crawl and walk and helps a little heart to fall in love with the sheer joy of responding to music.
 
• Together time. A Kindermusik class is truly the essence of “quality time,”offering you a place to create special memories with your child, gain new insights into your child’s development, and nurture your child’s natural love of music.
 
• Expert advice. A Kindermusik educator explains “what-to-watch-for” every step of the way and how each activity enhances your child’s complete development
• Learning continues at home. With the home materials, the learning continues at home with your child’s best teacher—you! 
Kindermusik is offering two free preview classes at the Lamaze Family Center Ann Arbor on Wednesday September 11th. The Kindermusik Village (babies 0-18 months) preview will be held at 9:30am and the Kindermusik Our Time (toddlers 18 months-3.5 years) preview will be held at 10:30am. Registration is not required, but it gives us an idea of how many people to expect. You can register here.
Regular Kindermusik classes at Lamaze Family Center start on Wednesday September 18th.


Signing Smart is another valued Lamaze Family Center partner offering fall classes.
By participating in a Signing Smart class, you can learn songs, signs, and activities to help your child communicate frustration-free. 
Signing with your hearing infant or toddler (6 months to 2 years) is an intimate experience that enriches your bond with your child while promoting speech, conceptual development and long-term learning. 
With Signing Smart your child can express his needs and interests, which results in less frustration and fewer tantrums. Your child can finally "tell" you what's on her mind-long before she can speak!
Signing Smart is offering a free preview class on Saturday September 7th from 11:00-11:45am at Malletts Creek Library. Registration is not required, but it gives us an idea of how many people to expect. You can register here.

Regular Signing Smart classes at Lamaze Family Center start on Tuesday September 17th.

Come check out the free preview classes and open up a whole new world of learning for your baby or toddler. We hope to see you there!