Friedman's Curve is a Bunch of BS!

Read it and weep, one centimeter per hour devotees!! Muahahaha!!

This is an incredible piece of research. If read and implemented, I think it could save SO MANY women from the pitocin-epidural-cesarean cascade. There is also an excellent review of the article on Academic OBGYN. Check it out! If you want the full article, shoot me an email or comment and I will send you a PDF. The formatting gets messed up if I try to post it here.

Enjoy!

The Natural History of the Normal First Stage of Labor

Zhang, Jun PhD, MD; Troendle, James PhD; Mikolajczyk, Rafael MD, MSc; Sundaram,
Rajeshwari PhD; Beaver, Julie MS; Fraser, William MD, MS
Obstetrics & Gynecology
Issue: Volume 115(4), April 2010, pp 705-710
DOI: 10.1097/AOG.0b013e3181d55925

Abstract

OBJECTIVE: To examine labor patterns in a large population and to explore an
alternative approach for diagnosing abnormal labor progression.

METHODS: Data from the National Collaborative Perinatal Project were used. A
total of 26,838 parturients were selected who had a singleton term gestation,
spontaneous onset of labor, vertex presentation, and a normal perinatal outcome.
A repeated-measures analysis was used to construct average labor curves by
parity. An interval-censored regression was used to estimate duration of labor
stratified by cervical dilation at admission and centimeter by centimeter.

RESULTS: The median time needed to progress from one centimeter to the next
became shorter as labor advanced (eg, from 1.2 hours at 3-4 cm to 0.4 hours at
7-8 cm in nulliparas). Nulliparous women had the longest and most gradual labor
curve; multiparous women of different parities had very similar curves.
Nulliparas may start the active phase after 5 cm of cervical dilation and may
not necessarily have a clear active phase characterized by precipitous dilation.
The deceleration phase in the late active phase of labor may be an artifact in
many cases.

CONCLUSION: The active phase of labor may not start until 5 cm of cervical
dilation in multiparas and even later in nulliparas. A 2-hour threshold for
diagnosing labor arrest may be too short before 6 cm of dilation, whereas a
4-hour limit may be too long after 6 cm. Given that cervical dilation accelerates
as labor advances, a graduated approach based on levels of cervical dilation to
diagnose labor protraction and arrest is proposed.

Slightly drunk on a summer night

I must say: it is a really lovely feeling to ride my bike through the city slightly drunk on a warm summer night, after laughing a lot with good girl friends. This must be what youth is about.

Good Day, Sunshine

I don't have a lot to say today except that it was a good day. I woke up to sunshine streaming in through our bedroom window. Alex and I had a good snuggle while we listened to housemates making breakfast downstairs. When we figured it was about ready, we headed downstairs and were treated to yummy porridge in the breakfast nook with our homies.

I forced myself to do paperwork all morning, and studied, then in the afternoon I rode up to McPhereson's Produce Stand and splurged on summer fruit-two kinds of cherries, grapes, papaya...and ingredients for spring rolls. My giant new grocery delivery basket on my bike works like a champ-three bags of groceries, no problem! I spent the afternoon making spring rolls until my fingers got pruny from pulling the rice wraps out of the water. Alex and I had a backyard picnic, watched the clouds, and I started a new book (The Bicycle Diaries, by David Byrne).

When we got bored we headed down to Full Tilt Ice Cream for some delish cream and pinball. I got Thai Iced Tea vegan ice cream, and Alex got the classic Ube flavor. We detoured on our way home to watch a spectacular sunset over the sound, mountains, and city skyline from Jose P. Rizal park. We were among several other pairs of lovebirds, and one lonely looking Latino man watching the sunset from his tiny, old red car. As we were sitting there we saw three Airlift Northwest flights dropping folks off at the helipad behind Harborview. It was strange to be having such an incredibly peaceful and content moment with my lover, and know that at the very same moment there were nurses and doctors in Resus Rooms 1, 2, and 3 trying to save people's lives. I was grateful to be on my side of the moment.

Our little chicks are spending their first night outside tonight. Up to now they've either been in our dining room under a heating lamp or in the garage under a heating lamp. They've had brief adventures in the chicken tractor during the warm part of the days, but tonight is the first night that they're on their own out there for the duration. It reminds me of kids having their first "camp out" in a tent in the back yard. Alex and I have been simultaneously worrying over them and glad they're out there growing up. They're teenagers now, after all. Last we checked, they were in a chick cuddle puddle in their nesting box in the chicken tractor. They seemed quite content, but we brought them some extra food and bedding just in case. I hope they do OK out in the big world tonight!

Purple Scrub Safari

So....I woke up this morning with a clear idea of how my day would go. I had a study group in Madison Valley from 9-12, then a group photo for at my clinical site at 1pm, then miscellaneous finals week tasks to do until dinner time. I rolled out the door and got to Madison Valley just fine. We got all the new study guides for the final done! But then, things took a turn. I had an adventure. Well, a misadventure.

I used the new bike maps feature on Google Maps to plan my route from Madison Valley to Children's. It routed me through Broadmoore, which I thought was a little odd, but probably quiet and peaceful and safe, so away I rode (directly up hill-Madison Valley is not called a "valley" for no reason) towards Braodmoore. For non-Seattlites, Broadmoore is a gated, private neighborhood of mansions inhabited by the bougousie, plunked down in the middle of a major public park, the Arboretum. Only in Seattle, dudes, only in Seattle. I was admitted to Broadmoore once, to attend the board meeting of a non-profit I was involved in. I wasn't involved in that non-profit for long. It turns out Broadmoore does not allow bicyclists to roam it's golden streets, and so I had to continue past the guarded gates and take the main road, Lake Washington Blvd, through the arboretum. It's a nice route, flat and tree lined, except that it's also a major traffic route. Two lines of twisty, winding, narrow pavement, traversed by many an SUV-and me in front, holding up the show. There is no shoulder. But, to be honest I have no qualms about holding up traffic whatsoever. If they want bicyclists not to hold up traffic, maybe they should build some decent bike paths, eh?

Now we get to the misadventure part. Following Google's directions, I took Foster Island Rd out to the waterfront trail. It turned out not to be so much "water front" as "water covered." It was ok, if just slightly muddy for the first quarter mile or so. Then it got a little more muddy, but still passable if I walked my bike. Then suddenly, in a single step, I was knee deep in swamp mud. The kind of swamp mud that sucks your shoes off. Swamp mud also smells like shite, a familiar and comforting smell to a girl who spent many happy hours playing in the swamps of south Georgia, but definitely still a shite smell. Did I mention I was wearing my purple scrubs to pose for a group photo in a hospital? Last I checked, most hospitals do not welcome with open arms students covered to their knees in foul smelling mud, nor does it make for a lovely, professional photo. I was half laughing, and half cussing as I extracted myself-with both shoes, miraculously-from the mud. "Ha!" I thought to myself. "Nice try. I'm made of tougher stuff than that!" I decided to get through the rest of this god-forsaken trail, then pause at the sylvan water's edge and wash the shit off my scrubs and running shoes and hope they dried out a little bit on the rest of the ride to the hospital, which I now had about 20 minutes to make. A brilliant plan, no? I made it through the rest of the mud, and finally returned to the maintained, wood chipped part of the trail. Along the way, I noticed not one, but two pairs of abandoned running shoes on the trail! I was clearly not alone in my woes. Now that I was through the mud it was time to implement my wash-dry-look decent plan. I leaned my bike against the railing, stuck my left foot in the water, shook it around, and was relatively pleased with the mud removal accomplished. Next, I stuck in my right foot. Next, while balancing on my left foot, I fell into the water up to my thighs. Damn. It. It was a long, cold, wet ride home. I really turned heads, let me tell you.

So, here are the bummer things about that bike ride:

1) Google bike maps can kiss my patooty

2) I failed (FAILED!) to deliver the cards I had for students to sign for the nursing staff who have so kindly allowed us to breathe down their necks, step on their heels, and ask really dumb questions all quarter. I will get them to them somehow, but dadgumit!

3) Someone will have to photo shop my head onto Jennifer Anniston's body, and then make it look like Jennifer Anniston is wearing purple scrubs, and then insert that into the group photo.

Here, though, are the great things about that bike ride:

1) If you have to fall on your butt, it's really much nicer to do that in mud and water than going 30 MPH on pavement, which is what I was doing only a few minutes before I fell in the water. I think fate was looking out for me, in a dysfunctional kind of way.

2) I quite enjoy wallowing in mud. I think it's romantic. The most romantic thing I've ever done in my life was picking raspberries in a cold drizzle, ankle deep in muck, at the foot of the Cascades with Alex.

3) That was, sadly, the most adventure I've had since my 5k/Polar Bear Plunge in January! I really need to get out more!