The labor curve of the grand multipara: Does progress of labor continue to improve with additional childbearing?

The Impact of Parity on Course of Labor in a Contemporary Population

“…Gurewitsch et al compared average first‐stage labor curves for nulliparous, lower parity multiparous (parity 1–4), and grand multiparous (parity ≥5) women (10). Similarly to Friedman's earlier publications, the authors showed that the average labor curve of lower parity multiparas was distinctly different from the average labor curve of nulliparas.…”

“…Second, studies on labor progression often restrict their sample populations differently. For example, some studies included only women with a spontaneous onset of labor (4,7,9–11,13), whereas others also included those with an induced labor (2,3,6,18). In addition, some studies further excluded women who delivered by cesarean section (7,9,13,18).…”

“…Moreover, the latent phase of labor appeared to shorten slightly with additional childbearing (3). Subsequent work by Friedman and others over the next three decades confirmed these findings (4–11). These trends are partly due to lessened uterocervical resistance and increased uterine efficiency among multiparas (12).…”

“…However, few studies have examined in depth the labor progression of multiparas to determine if being parous beyond the first birth has any additional impact (6,10,11,13). Furthermore, obstetric practice has changed substantially in the past 50 years.…”

Does Increase in Birth Weight Change the Normal Labor Curve?

“…Our labor curves are consistent with previous studies by Zhang et al and Gurewitsch et al, suggesting that active phase labor may begin at 6 cm. 6,9 Gurewitsch et al specifically showed this in women with parity above four, which was 4.3% of our multiparous patient population. 9 Women with the smallest fetuses, < 2,500 g, in this cohort had the shortest active phase, as measured by our centimeter to centimeter progression, but a higher cesarean rate.…”