Dr. Caroline Friedman and Dr. Fox answer common questions about labor. How long is labor? What can patients expect? When is a C-section necessary? They also review the Friedman Curve, which obstetricians use to determine whether labor is abnormal.
“How long is labor and what’s the deal with the Friedman Curve (no relation)?” – with Dr. Caroline Friedman
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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Caroline Friedman, welcome back to the podcast. How goes it?
Dr. Friedman: Thank you. It’s good. All good. How are you?
Dr. Fox: I’m wonderful. How’s your summer been?
Dr. Friedman: It’s been nice. I’m always a fan of sunshine and warm weather. So, can’t complain.
Dr. Fox: Well, we definitely have had warm. It’s been hyper warm.
Dr. Friedman: Yes it has.
Dr. Fox: Not good for someone whose air conditioning is on the fritz, hopefully being fixed as we speak.
Dr. Friedman: Oh, goodness. Good luck.
Dr. Fox: Good luck, indeed. So, we’re talking today about a really interesting topic. And it’s sort of titled, “How long is labor?” What’s normal? What do we do? Like, how long is my labor going to be? At what point do you say it’s abnormal? When do I have a C-section? All these things. And it is legitimately complicated. Part of the reason that it’s also so interesting and why I wanted to have you on is probably the most famous study of this came out with something called the Friedman Curve.
Dr. Friedman: Right. I wish I could take credit.
Dr. Fox: Every training obstetrician and midwife, maybe in the world, but certainly in the U.S., knows, loves or hates, but knows the Friedman Curve. And it’s not your curve, you’re saying?
Dr. Friedman: No, no, before my time, I think.
Dr. Fox: Before your time. Dr. Emmanuel Friedman. Uncle Manny.
Dr. Friedman: Yes.
Dr. Fox: Excellent. So, yeah, we’ll get into that. But, you know, when people ask you this question, just sort of broad strokes, high level, how do you talk to them about, like, the length of labor, what it’s supposed to be?
Dr. Friedman: Well, like most things in pregnancy, it’s complicated. There’s not a clear answer. A lot of individual factors. But we talk about the fact that there are different sort of stages of labor, we call it, there are different parts of labor. And so, asking the question of how long is labor really depends on, you know, what specifically you’re talking about. Are you talking about active labor? Are you talking about latent labor? Are we talking about the part of labor where you’re pushing, you know, potentially? And it all kind of depends on what’s going on with your body, what number baby it is, whether we’re inducing you or you’ve come in in your own labor, things like that.
Dr. Fox: Yeah. And there’s so much variation. I mean, you’ll hear people say, “I was in labor for three days,” right? Someone else will say, “Yeah, my water broke, I started contracting, and the baby came out two hours later,” and you’re like, “Whoa,.” Like, that is a massive difference. And it’s not like, you know, I guess it’s better for the baby to come out quick than a three-day labor. So, we’re gonna say better or worse, I guess I’d rather have a quick labor. But it’s not like one is sort of normal and one is abnormal, necessarily. There’s definitely a lot of human variation in this. And so, we try to not focus too much on calling something normal or abnormal, because it just means it’s maybe like different, or if you look at a bell-shaped curve, maybe some people on one end sort of more fast laborers and other people are on another end more slow laborers.
Ultimately, it’s really about, however long the labor is, is it safe? Right? Is it okay to continue labor that long or should we be intervening either to speed it up, potentially? People have questions about that. Or sort of more drastic to say, you know what, we’re putting an end to this, and we’re doing a C-section. And these are not “black and white” decisions. There’s a lot of thought that goes into each of these decisions. And I think it’d be really nice in this podcast to sort of, you know, talk about these ideas so people get a sense of what we’re thinking about when we’re helping people in labor, or what their doctor might be thinking, what their midwife, what their labor nurse, and sort of to get a better sense. So you talked about this idea of stages of labor. So, what do you mean by that? What are the stages of labor?
Dr. Friedman: So, technically speaking, there are three stages of labor. The first stage is sort of what we consider anything when you’re…once we’ve decided you’re in labor, your cervix is starting to dilate, you’re contracting painfully, whether it’s naturally or because we’ve given you something to make you contract, while the cervix is dilating up until the point where the cervix is what we call fully dilated, which is about 10 centimeters of dilation. And so, a non-laboring, non-pregnant cervix is what we call closed, meaning there’s no dilation, and then it will slowly start to dilate. And so, that time that it takes, which, again, could be a couple of hours to three days, potentially, of cervical dilation is the first stage.
Then, once you reach that full dilation, that 10-centimeter stage, begins what we call the second stage, and if the plan is to try to have a baby vaginally at that point, then that’s when we usually either allow a patient to what we call labor down, just sort of hang out at 10 centimeters and try to see if gravity will do it and the contractions will do it and help bring the baby down, and then also the pushing part, where mom’s efforts help to push the baby out. And then there’s the third stage, which is essentially the time after delivery of the baby until the placenta is delivered. And relative to the other stages, that one is usually pretty uneventful and pretty quick and often not something that the mom really needs to worry about or be involved too much in.
Dr. Fox: Right. Or even realizes that we’re thinking about that as a stage…
Dr. Friedman: Exactly.
Dr. Fox: …of labor, so to speak. Yeah, I mean, the longer part, the first stage is what people think of as like the labor portion, and the second stage is like the pushing portion, and then the third stage, they’re like, “What? There’s a third stage?” “Yeah, that’s our job with the placenta.”
Dr. Friedman: Right, exactly. You enjoy the baby.
Dr. Fox: One of the interesting things you mentioned was this idea of when does the first stage… Like, what’s the starting point? We know what the ending point is, it’s when the cervix is fully dilated. And the second stage, all right, we therefore know when it starts, and we know when it ends because the baby comes out. What’s sometimes hard to pin down is when does labor actually start?
Sometimes people say, “I was in labor for three days,” but in fact, they were only in labor for 12 hours, they were just contracting for two-and-a-half days. And so, on our end, so we define labor as when you have both regular painful contractions and the cervix is opening. Because you could have one or the other. Some people, their cervix open slowly, and they come to the office, and they are 2 or 3 centimeters dilated, but they’re clearly not in labor because they’re not contracting, and there are others who they’re contracting and they could be painful, they could be annoying, you know, any level of discomfort, but their cervix is totally firm and closed for a few days. They’re also not in labor, they’re just contracting. Which is very stressful for a lot of people that they’re not yet in labor yet they’re in pain, but by definition, they’re not in labor.
So we sort of need to see both happening. That’s true at the end of pregnancy, and same thing when we’re talking about preterm labor, that’s how we define it in the preterm period as well, they need to have both. So, when that happens until the cervix is fully dilated, we call that the first stage. And I think that the other thing you mentioned, which sort of confuses some people is, within the first stage, you mentioned latent and active. So, conceptually, what is latent labor versus active labor?
Dr. Friedman: So we generally think about latent labor as kind of that first part of labor, when your cervix is less dilated, and progress can be a little slower, and your contractions may be a little bit more irregular in both frequency and intensity. And then active labor is towards the end of that process, the exact cut-off, again, is a little unclear and a little variable from person to person. But that’s generally when the cervix dilates more quickly, in a little bit more of a predictable fashion, and the contractions are generally pretty regular, frequent, painful, unless you have an epidural at that point, but still, in theory, it would be more intense.
Dr. Fox: Yeah. And I think that, you know, for women who have had children before or for, you know, whether it’s doctors, or midwives, or med students, or people who have observed women in labor, we’ve all sort of seen this idea that the first part of labor is this slow process. Someone’s contracting for four hours and they’re 3 centimeters, and then they’re contracting for another four or six hours, and they’re 4 centimeters, and then they’re contracting for four hours, and they’re 5 centimeters, and then an hour later, they’re 9 centimeters, and an hour later, they’re pushing. And it’s sort of this slow, slow, slow and suddenly fast.
And that’s where, you know, your good friend, Dr. Friedman, the other Dr. Friedman, came in and he sort of mapped this out in the ’60s. And his curve is this basically this will be called sigmoidal shape, where there’s the beginning part of the curve where he mapped out sort of time in hours on the x-axis and how dilated the cervix was on the y-axis. And so, there’s this very sort of like steady slow slope line moving upwards. And then at a certain point, it just shot up. With each hour, the cervix dilated a lot more. And his data, it happened generally around 4 centimeters dilated, that’s what he found. It was variable, some people, their cervix starts dilating rapidly at two, and some people at three, and some people it’s five. But on average, it was four.
And because of that curve that he produced, I mean, literally in the ’60s, everyone was managing labor in a way that if a woman was not following that curve, there was something wrong. There was something abnormal. And that’s where the term like either labor dystocia came about, or abnormal, or prolonged, or delayed, or things like that, or, you know, arrested labor, all of these terms. And at least when I trained, we were very…we were sticklers about the labor curve of Friedman. We looked at it, we thought about it, we mapped it out, you know, 1 centimeter per hour, 1.2 centimeters per hour, 1.5 centimeters per hour, we had all this math. But it sort of got a little more lax over the years.
Dr. Friedman: Yes. As C-section rates went up in the country, there were various attempts to sort of look at why. Why were C-sections happening and what could we do to try to prevent C-sections. And so, there came a lot of discussion about, well, maybe not all labors are “abnormal” if they don’t follow exactly the Friedman curve. And so, they started looking at it again. And thought, maybe things happen a little bit more slowly than we previously thought, and maybe that active phase doesn’t start for everybody at 4 centimeters. And in fact, we think probably now it’s closer to six centimeters or so for most people.
Dr. Fox: Yeah. And what’s really interesting is, you know, when people started to question the Friedman curve, there was a guy named Dr. Zhang who published a lot on this. And it was really in the past 10, 20 years, and he sort of developed, it wasn’t even a curve anymore, it was more just like a line that everyone developed…their cervix dilates a lot slower than Friedman sort of documented himself. And like you said, if there is an inflection point where it gets quicker, it’s usually around 6 centimeters. And people thought that maybe sort of women have changed, potentially, over the past 30, 40 years maybe because women either have better nutrition, or maybe they don’t smoke, or maybe they’re, on average, older versus younger, or maybe they’re heavier versus lighter. All these things. But what’s really fascinating, a lot of people don’t know this, is, Zhang went back actually and looked at data from the time of Friedman in the ’60s, and found it to be the same.
The way you sort of map these out is very complicated because not everyone gets examined at exactly the same time. So you have to sort of do all these logarithmic calculations that’s way above my head for how he did it. But essentially, it doesn’t look like women or labors have changed, it’s just sort of how we examine their labor curve has changed a little bit. So, yes, we’re definitely a little more lax. I mean, you trained in a few years after I did, and when you were training, did people even talk about the Friedman curve? Did they sort of stick to it or did they just sort of taught it and said we don’t use it?
Dr. Friedman: Yeah, the latter. It was sort of, you know, let’s talk about it, but we’re gonna not follow it so much anyway.
Dr. Fox: Did that upset you, because you’re a Friedman?
Dr. Friedman: No.
Dr. Fox: It definitely has led to sort of a greater acceptance, I would say, on the part of doctors. Midwives were always pretty accepting of longer labors, they were definitely ahead of the curve in this regard. But at least with doctors more accepting of longer labors and giving people more time in the attempt, again, like you said, to lower the C-section rate, or lower interventions, potentially. There are some risks to longer labors, which are well known. And we talk about that. Risk of infection, you know, the longer you’re in labor, the longer your…membranes can rupture, you could have an infection for you and the baby. It doesn’t tend to be life-threatening, but, you know, it’s a risk. And the big one is higher risk of bleeding, hemorrhage after delivery. And these are both well known. So you have someone who’s in labor, how do you make a decision about what to do? Like, for example, do you have any cut-offs for, “Hey, I think this is going too slow and I’m going to intervene?” Or is it just sort of your overall Gestalt? Like, what do you do?
Dr. Friedman: It’s definitely Gestalt. And, you know, it also is assuming that mom and baby are doing fine, the best that we can tell. In terms of a cut-off, you know, for that first part, that latent phase of labor, I really try not to have a cut-off, assuming everybody’s doing fine. And pretty much every time either mom or baby will… If labor is never progressing out of that latent phase, either mom or baby will start to not tolerate it, or they’ll get past that phase. And so, I’ve never really or very rarely have I ever had to say, “No, you’re in labor, but you’re still in the latent phase and it’s been too long, so I think we should do a C-section.” Usually what happens is you get into more active labor, at which point it’s a little bit easier to assess whether things are progressing appropriately or not, or the baby is not tolerating it, or something else is happening that makes us want to deliver you sooner.
Dr. Fox: Yeah. And I think part of the reason a lot of people find this difficult is, there’s so much gray here. I mean, if you think about it, if we did nothing and people labored forever, without anyone tending to them, the baby is going to come out, right? It’s not like they’re going to have a C-section naturally, the baby will deliver. However, we know that there is a point after which it’s become more dangerous to labor than to do a C-section. And we know that because of historical data before the time of C-section, women died in labor, babies died in labor, horrible things happened. And so, we know that that’s not the right way to do it.
If you look at some other, you know, countries around the world where there’s poor access to healthcare, they either labor at home continuously, either because they don’t go to a hospital, or they can’t get to a hospital, there is no hospital to go to, whatever it is, again, that’s where you see women who have, you know, mortality rates in labor and babies dying, and terrible things happening with their bladders and fistulas and really bad things.
So we know that a world without cesareans is not great. And so, the question is, how do you know? How do you know when you’ve hit that point where it’s more safe to switch to a cesarean than it is to continue to labor? And there isn’t like a light that goes off or an alarm that goes off, and you can’t use a hard cut-off in terms of just hours, say after X hours, because that’s not going to be the right way to do it. Because for some women, you’ve waited too long, and other women, you haven’t waited long enough. And so, you have to really individualize that, and who could do that? Right?
So that’s where all of our training, and experience, and reading, and practice, and all these things come in. And for anyone, you know, if I’m there with someone, it’s hard for me to explain why my… Whatever, 20 years and thousands of deliveries lead me to think a certain way, they just do. And for someone, it’s like, why? It’s like, well, it’s hard to say why. There’s something not right here, or, “Don’t worry, there’s something is right here.” And I just think people have a very hard time letting go of that and just giving it over to someone else to make those decisions. It’s difficult. We’re not used to that.
Dr. Friedman: Right. No, we’re not. We’re used to having answers and having clear-cut things, and I get it, but it’s definitely an art.
Dr. Fox: Yeah. It’s also hard because there are different ways to do it. I mean, we know that there’s one way of “managing” labor is to be kind of what we say expectant, which means hands-off. As long as things are healthy, let things go as they would naturally, don’t intervene, just let it be and just keep an eye on mother and baby. And that’s one way to do it, again, unless necessary, so to speak. And there’s another way where you sort of proactively try to get things faster from the beginning, which sounds impatient or something very doctory. But actually there’s data that it’s not a bad thing. Something like rupture membranes early, and if contractions space out, start Pitocin early. And that it leads to as good or maybe better outcomes than just waiting. And so, both of those are legitimate and people do it differently. But it’s not like if you have someone who’s just sitting back that they’re lazy or someone who’s like breaking the water early that they’re like nuts, it’s all reasonable under sort of management of labor, and people use their judgment of what’s best for each person. Do you tend to be more expectant or more active, in a sense?
Dr. Friedman: I think a combination. I think a combination. And again, it really depends. If someone’s coming in and very already good labor pattern and making progress, you know, it’s things are fine. But if someone’s been either unstable, or has been contracting for days and still hasn’t done things, and sometimes breaking water and giving a little Pitocin can be very helpful. So, I think it really just depends.
Dr. Fox: Right .The question I get a lot, either in labor or sometimes before is, well, we know that Pitocin increases the risk of a C-section. So how do you answer that?
Dr. Friedman: I generally tell people that’s not true.
Dr. Fox: False
Dr. Friedman: False. That we know that that’s not the case. There are a lot of reasons why people think that. I think the internet is a scary place for information of all kinds.
Dr. Fox: Wait, the hot take by Dr. Friedman, there are things on the internet that are not necessarily correct. Somebody might be learning this for the first time. Yeah.
Dr. Friedman: I think Pitocin is complicated because the whole point of it is to make people contract more strongly and potentially more frequently because we’re giving it because the body is not doing it on its own. And so, labor with painful and frequent contractions can be stressful to a baby, whether it comes naturally or whether it comes from Pitocin. But when it happens naturally, there’s really no “one” or no “thing” to blame. But if we are giving you Pitocin and then something happens, it feels like the Pitocin or the doctor that gave you the Pitocin is the one who caused it.
Dr. Fox: Yeah. I mean, Pitocin has the potential to cause harm. Obviously if you give it incorrectly in the wrong dose too much. Yeah, sure, someone could contract too much, it can cause problems. But it’s really not the way we give it, we start very low and we what’s called titrate it, a little bit more, a little bit more like every 20, 30 minutes until the contraction pattern is sort of regular and typical, and sort of what pretty much most women have in labor. And what I tell people is, if you do it correctly, Pitocin will decrease your risk of a C-section. The reason we’re giving it is because we’re worried that if we don’t give it, you’re gonna end up with the C-section, you know, because nothing is happening. If you’re 6 centimeters for 12 hours, like, you’re not dilating. So the Pitocin is your last chance, essentially, to get that going.
And I do think that it… Again, people, sometimes they’re just told something wrong, but other times you can actually…you could design a study that says that, yeah, 200 women in labor and the 100 that got Pitocin had a higher C-section rate. But yeah, you didn’t randomly give those 100 Pitocin, they got it because their labors were not progressing. And that’s the reason they had a C section, not because they got Pitocin. The Pitocin was the cure, it wasn’t the problem. And so, I think that’s something that’s important for people to know.
And the same thing like with breaking someone’s water. It speeds up the labor, it doesn’t cause a C-section. And we don’t have like a clock where after the water is broken, you must, by law, be delivered within a certain amount of hours or you shall have a C-section, it doesn’t work like that. You end up with a C-section with your water broken, it’s not because your water’s broken, it’s because something is not going right. And so, are there any parameters that you generally do use as sort of like a baseline for how you think about labor and how often you might examine someone in labor to see if they’re progressing?
Dr. Friedman: Yeah. I mean, you know, because we expect things to move slower in that latent part, we generally avoid, you know, doing exams too regularly. So, it’s not uncommon to go four or six-ish hours between exams. Once you’ve hit that 6-centimeter point when we think things are gonna get a little bit more active, the idea is that you may dilate about a centimeter per hour. And so, we usually examine you a little bit more frequently, maybe every two-ish hours at that point. Again, we don’t really use that as like a hard and fast rule of like, “Okay, well, it’s been two hours and you haven’t dilated exactly 2 centimeters, so I’m going to do a C-section now.” But, you know, if after four hours we expect you to dilate 4 centimeters and you haven’t made any change, maybe that’s a good time to talk about starting something like Pitocin, or breaking your water if it hasn’t already been broken, and going from there.
Dr. Fox: These are always conversations, it’s tough sometimes, which is why I like this podcast, because, I mean, to have an hour conversation with every single person in labor about, okay, here’s the Friedman curve, here’s how we think about this and all these things. So I think it’s good to come prepped. But essentially, I’m always sort of thinking, is the labor progressing in some fashion whatsoever? There’s a difference between having very slow progress versus having no progress. That’s number one. Number two, obviously, a huge variable is where are they, right? If they’re 3 or 4 centimeters, okay, we got lots and lots and lots of time. Whereas, if they’re 8 or 9, it’s a little bit unusual for that to happen and I’m more concerned.
But then there’s everything else that goes into it. Like you said, it’s a much different scenario if the baby’s heart rate is fine, the mother looks great, she’s healthy, it’s an uncomplicated pregnancy, everything looks fine. Yeah, you’re gonna be a lot more lenient with the labor because the risks are lower. But if you have a situation where, you know, the baby’s heart rate is dropping every time there’s a contraction, the mom has a fever, she’s got high blood pressure, she’s bleeding, she got medical problems, the baby’s very high up, it’s a big baby. Yeah, your lines your thresholds are going to be a little bit different because you’re always balancing risk and benefit. And that’s why you can’t just say, “After X hours, I do this. And after Y hours, I do that.” It has to be for each person. There are some people who, if they don’t make any dilation in two hours, I’m like, “Listen, for you, we’re done.” And there’s other people, I’ll give them 12 hours, right? It just depends on exactly what’s going on. There’s a lot that goes into that.
Do you find that, when the time comes that you think you have to do an intervention, whether it’s breaking her water, or giving Pitocin, or potentially recommending a cesarean, is it something that you find most people are quite accepting of, most people have a hard time with that? Obviously, there’s variation. But what has your experience been?
Dr. Friedman: I think it’s a little of both. My goal is to try to be as open and honest and communicative during the labor process so that nothing comes as a surprise, and that the patients know exactly, or as much as they possibly can, what I’m thinking and what I’m watching for. So that when the time comes to make those recommendations, hopefully they’re on board.
Dr. Fox: Right. Yeah. I think that there’s a lot of personality that goes into this. Part of why it’s an art is individualizing recommendations medically for each person. And part of why it’s an art is that this is interpersonal. This is like communication skills, and this is, you know, emotions, and this is so much on the EQ versus IQ scale of things and trying to manage labor. Because it’s not like when you’re a surgeon and you’re trying to deal with a complicated surgical thing, patient is asleep. You’re just like, it’s like you and the intestines, right? We’re gonna get this right.
And that’s very different focus from… And again, it’s not just the woman in labor, there’s her partner, potentially, her Doula, potentially, her mother’s in the room, she’s got someone on the phone. And there’s a lot of people to sort of navigate these decisions, and it’s not easy. So, patients out there, have mercy on us. We’re trying. We’re trying hard. So you get someone, she’s fully dilated, right? So the first stage of labor is over, success, she is fully dilated. Tell me about the second stage of labor.
Dr. Friedman: Well, now the fun starts. The second stage of labor is fun. I mean, it is. You’re getting close, things are exciting, but it’s work for the mom, naturally. It can be a little bit stressful. It’s a lot. And so, the idea is we push with contractions, and the process can be anywhere from a couple of minutes to a couple of hours.
Dr. Fox: Yeah. I think a lot of people are surprised to learn that with the first baby, the average amount of pushing, average, is an hour or more, which means that 50% of people, more than an hour. And people are like, “Say what? Pushing for how long?” Yeah. And that’s normal. Again, that’s just, that’s normal, that’s nature, that’s geometry at work, that’s trying to get that baby out of there. Fortunately, for people who’ve had children before, it gets usually a shorter amount of time, like, an average for a second baby, 20 minutes, right? So, that gets cut down a lot.
Dr. Friedman: Usually.
Dr. Fox: Yeah, usually, it’s average, it’s an average for people pushing. And some people are pushing for two, three hours. And again, it’s sort of the same concept that there are numbers you can read. It is unusual to have to be pushing for more than three hours, but it happens. It’s not like, at three hours, we have to do a C-section or do something. But it’s, in our minds, we’re like, “All right, are we doing the right thing? We have to reassess? Like, is it going to happen? Is it safe? Does the baby look okay? Are there going to be issues?” And so, we do think about it a little bit differently when it starts getting to two, three hours. But again, it’s not like a law or a hard rule that we have to do something.
Some of the other variables, like we said, besides first baby versus not first baby, sometimes for women with an epidural, it’s a little harder to get the hang of pushing. I find that pushing is actually the same. It’s sort of like when they sort of get it, right? There’s this idea that women with an epidural take longer to push. I think it’s just the front end. It’s like, you know, some people get it right away after two, three pushes, and other people it takes like 30, 40 minutes to sort of get the hang. Because they don’t have all the sensation, all that biofeedback of pushing. So, it’s…
Dr. Friedman: And it’s not something that most people have done before.
Dr. Fox: Right.
Dr. Friedman: Until they do it.
Dr. Fox: Right. But we’re there. We’re there to help and this is what we do. Labor nurse is there to help, doulas, potentially, you know, whoever’s there to help. This is where we all earn our keep, so to speak. And then, if there’s a concern in the second stage, that the head is not coming down at the right speed, or pace, or whatever you want to say, what are our options at that point?
Dr. Friedman: There are three, one is, as long as everybody’s okay, we can try to keep going. Manage expectantly. But if it really doesn’t seem to be making any progress, and mom’s getting tired, or the baby is done with it, depending on what the situation is, the options would be either a trial of an operative vaginal delivery or a C-section. And not everybody is a candidate for an operative vaginal delivery, and so, if that’s not really brought up, or it’s brought up but says, no, we can’t do it, it’s not the safest. Then that’s okay. It’s not that it’s always an option. It’s not like everybody gets the option of one or the other. But certainly, if we think it would be successful and we think it is a good option, then it’s usually addressed.
Dr. Fox: Right. And by operative, you mean vacuum or forceps?
Dr. Friedman: Right.
Dr. Fox: Okay. So, again, yes, for many women, those are options. One of the reasons it might not be an option that the head is too high, it’s just not safe for them. You could, in theory, do it, though it’d be very unsafe, so we would never try if the head is high. If the head is low enough in the pelvis, for people who know what they’re doing, it tends to be a quicker and generally safer process to do that than a C-section. But if the head is higher, it’s the opposite. And sometimes there’s, you know, options and decisions and people can choose. But again, if the person delivering the baby, or I guess the mother is delivering the baby, the person attending the delivery knows how to do forceps or vacuum, that generally is going to be safer and quicker for the mother and the baby than doing a C-section.
Now, does any of this change, in your own mind, when we look at a labor that’s induced versus a labor that’s what we call spontaneous? Because you said that, you know, spontaneous labors tend to go faster than induced labor. So, do your cut-offs change in any way?
Dr. Friedman: For the second stage, no. We just are more patient with the latent phase because the entire thing happens in the hospital. Whereas a lot of times patients who come in in their own labor will do at least a portion of the latent phase at home or before they come to the hospital.
Dr. Fox: Yeah. And when we did the podcast on induction, one of the big messages there was just what you’re saying, like, it takes a while, because we’re really like jumpstarting that labor process. But we’re sort of jumpstarting someone into the slow part, right? Once they get into the faster part of labor, it tends to move at the same speed had they gone into labor on their own, but that slow part and we’re, you know, quite lenient with time, again, as long as the mother’s fine and the baby is fine. That it may take a while, we’re talking 12, 16 hours of it in hospital. So, that is something. Excellent. Friedman.
Dr. Friedman: Yeah.
Dr. Fox: The Friedman Curve. Love it.
Dr. Friedman: I mean, I guess if we don’t care about the Friedman curve anymore, then I can make up something new with my name.
Dr. Fox: All right. Caroline.
Dr. Friedman: Good stuff.
Dr. Fox: Love having you on the podcast. You’re one of the fan faves.
Dr. Friedman: Excellent.
Dr. Fox: Go to the top of the charts and copyright, we did not take the Friedman Curve. Caroline has said that she has no ownership over whatsoever. But it’s great to have you. Thanks a lot.
Dr. Friedman: My pleasure. Thank you.
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