Many moons ago, we thought that once you reached 4cms, you were in “active labor” and the pace of your labor should start to pick up and keep going no matter what. In 2010 Zhang and colleagues published a groundbreaking research study that re-examined labor patterns and redefined the beginning of active labor as starting at 6 centimeters! This was a HUGE academic smack-down of the 50+ year standard of Friedman’s curve that defined active labor as starting at 4cms.
Why does it matter? The BIGGEST reason physicians were recommending cesarean section in 2011 was “arrest of labor” or “failure to progress” and apparently they were making the call far too early! You can read more about that whole thing here. After this study was published, the American College of Obstetrics and Gynecology (ACOG) came out with this position paper saying, whoa, let’s slow down this trend in the rise of cesarean births, and even outlined why and how. That position has since be reaffirmed multiple times by ACOG, BUT, I am still not seeing all local providers using this evidence in their practice and I still hear some providers and staff telling people that they are in active labor when they are 4cms. Look, your Aunt Becky might not know the evidence, but you surely hope the people taking care of you are up to date on best practices from 5+ years ago right?
The evidence is clear: If you are 4cms dilated, you are NOT in fact, in active labor. Your labor still has a chance to stall out or even stop. While that is frustrating news if you are in that position, it is also good information to have in case someone might suggest that something is wrong because labor stalls and that you need to DO something about it. Labor takes time and patience. If you are not in active labor yet, leaving is actually an option. (And no, your insurance will not refuse to pay, that is a myth that has been debunked many times over including here.) As long as everyone is safe and healthy, asking for more time to allow your labor to progress without unnecessarily intervening with medicine you might not need is NOT an unreasonable request. Remember to use your B.R.A.I.N (Benefits, Risks, Alternatives, Intuition, & Nothing or Not Now), sometimes that N of NOTHING is important to remember to request!
As your doula, it is my job to know that 6 centimeters is when active labor begins and to help you remember to ask great questions about your care! Getting to 6 cms is typically what takes the longest time, and I help people cope with getting there physically too. I promise I do try not to geek out too much while hanging with clients in labor, but it does happen.
So remember 6 centimeters is when active labor begins!