Which obstetrician was the first to oppose arbitrary limits on the length of labor?


Can you guess who wrote this?

The usual diagnostic criteria in use nowadays invoke arbitrary standards of total duration of labor, beyond which abnormality may be considered to exist… Thus, for example, labors lasting longer than 24 hours are usually deemed to be abnormal and, therefore, to warrant consultative evaluation. This practice gained general acceptance, not so much because the criterion of duration is diagnostic (which I hasten to insist it is not), but rather because there is a relation between prolonged labor and increased fetal morbidity and mortality… [N]ot all labors which exceed these uncritical limits subject the fetus to comparable risk. The single guideline of duration, therefore, must be considered as much too coarse and insufficiently definitive to permit us to specify precisely which patients are at risk … (my emphasis)

How about this?

The physician is confronted by a wide range of normality in terms of patterns of contractility. At one extreme is the patient with negligible contractions; her cervix is dilating unobtrusively while we try to determine whether or not she is in labor… At the other extreme is the woman who suffers contractions of great intensity and frequency that may continue for many hours before cervical dilatation becomes apparent… Yet both are normal variants and the physician with enough experience will recognize their inherent differences. (my emphasis)

Or this?

Continued progress should be expected if patients with protraction disorders are properly managed in a conservative manner. The prognosis remains good as long as progress continues. There appears to be only a very small increase in risk to mother or infant from these conditions, provided no ill-advised measures for stimulation or-even more important- for traumatic delivery are undertaken. Expectancy is very strongly recommended. (my emphasis)

Or this?

Arrest of dilatation or of descent is a most serious abnormality and carries an especially poor prognosis for vaginal delivery. Many patients with these patterns ultimately require cesarean section because of disproportion. Where pelvic relations are adequate, the prognostic outlook for vaginal delivery is much better. One can determine the prognosis more carefully … if one compares the rate of progression … with the rate that occurs after treatment [with Pitocin] for the arrest… The more rapid the postarrest slope, the more likely is vaginal delivery. Patients whose postarrest slope is more than 2 cm./hr. greater than the prearrest slope should all be expected to deliver vaginally. None should require cesarean section unless it is indicated for some other reason, such as fetal distress… (my emphasis)

All of these statements come from a 1972 paper, An objective approach to the diagnosis and management of abnormal labor, by Dr. Emanuel Friedman of the eponymous Friedman Curve.

Surprised? You shouldn’t be. The new ACOG report on preventing primary C-sections is not a rejection of the Friedman Curve, but rather revisits first principles of the Curve is and how Dr. Friedman thought it should be used.