Physiological plateaus during normal labor and birth: A scoping review of contemporary concepts and definitions

Abstract

Background Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and clinical practice. To date, heterogeneous conceptualizations and terminology have impeded effective communication and research in this area, raising concern as to whether some physiological plateaus might be misinterpreted as dystocia. To address this issue, we provide a point of orientation, mapping contemporary concepts, and terminologies of physiological plateaus during normal labor and birth. Methods We conducted a scoping review, considering published and unpublished reports of physiological plateaus, reported in any language, between 1990 and 2021. Database searches of CINAHL, EMBASE, Emcare, MIDIRS, MEDLINE, Scopus, and Open Grey yielded 1,953 records, with an additional 35 reports identified by hand searching. In total, 43 reports from eleven countries were included in this scoping review. Results Conceptualizations of physiological plateaus are heterogeneous and can be allocated to six conceptual groups: cervical reversal or recoil, plateaus, lulls during transition, “rest and be thankful” stage, deceleration phase, and latent phases. Across included material, we identified over 60 different terms referring to physiological plateaus. Overall, physiological plateaus are reported across the entire continuum of normal labor and birth. Conclusions Physiological plateaus may be an essential mechanism of self‐regulation of the mother‐infant dyad, facilitating feto‐maternal adaptation and preventing maternal and fetal distress during labor and birth.

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

“…A scoping review on physiological plateaus during normal birth reports on "lulls", a phenomenon where the intensity of labour decreases temporarily before expulsive contractions commence, another description is the "rest and be thankful" stage, occurring around the time of full cervical dilation where contractions slow down or stop temporarily before expulsive contractions commence and a third description of this phenomenon is the "latent phase" where uterine contractions may temporarily decrease in frequency and intensity as the fetus descends through the pelvis. The duration of the "rest and be thankful" stage was reported to be between a few minutes and several hours (34). These descriptions are in line with those from the focus group discussions.…”

“…Recognising normal variation in labour has been described in an Australian study that sheds light on plateauing labours. The experts' opinions in this study suggest that physiological plateaus exist and appear to fulfil a valuable function for the self-regulation of normal childbirth instead of plateauing as a "failure to progress" (33,34).…”

“…Explanations for physiological plateaus during labour is that stalling or pausing labour patterns is a method of self-regulation of the mother-infant dyad where maternal exhaustion or emotional agitation is reported as potential causative mechanisms of plateaus (34), and the fetus may initiate a plateau in response to increasing head pressure. Midwives in Study I and the midwives in the scoping review (34) described the transitional phase as forgotten and stated that modern labour care demands continuous progress leading to medical interventions. There was, however, a concern during the focus group discussions that it could be difficult to recognise when there was a "natural pause" in the labour and when prolonged labour occurred, which indicates the complexity of this phenomenon.…”

Techniques used during childbirth to correct fetal position and improve labour process

“…An awareness of the natural moments of slowdown in labour or even lack of progress in labour is essential (Weckend, Davison and Bayes, 2022). It is advisable to accept situations in which not action solves the problem, but the time and patience.…”