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Promoting Progress In Labor

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According to the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine, a critical element for reducing primary cesarean birth is the reassessment of current maternity care practices related to interventions, such as induction of labor and implementing care practices that support spontaneous labor progress.2Failure to progress or dystocia is the primary cause of nearly half (47.1%) of all intrapartum cesarean deliveries.3Despite widespread use of interventions to speed labor progress, including use of oxytocin and artificial rupture of membranes, the diagnosis of disorders of labor progress appears to account for a large proportion of the increase in cesarean rates over time4and the variation in cesarean rates across geographic regions.5,6 Recent research reports have concluded that new definitions of normal labor progress and of labor dystocia are required to avoid over diagnosis leading to unnecessary cesarean births. 2,7-10 In addition to usingnew definitions, there are expanded approaches to supporting spontaneous progress of labor during the first and second stage. The ACNM Reducing Primary Cesarean Bundle for Promoting Labor Progress presents several action steps that can be used to implement these new approaches. Further discussion of supporting spontaneous labor progress, including the transition to the hospital setting, can be found on the following pages:

Click to view additional resources available in the Promoting Progress in Labor Resource Toolbox, or search our resource library by clicking here.


  1. Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to mothers II: report of the Second National U.S. Survey of Women’s Childbearing Experiences. Published October, 2006. Accessed March 2, 2014.

  2. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus: safe prevention of the primary cesarean delivery. Published March, 2014. Retrieved March 2, 2014.

  3. Zhang J, Troendle J, Reddy UM et al. Contemporary cesarean delivery practice in the United States.Am J Obstet Gynecol.2010;203(4):326.e1-326.e10.doi: 10.1016/j.ajog.2010.06.058.

  4. Barber EL, Lundsberg LS, BelangerK, et al. Indications contributing to the increasing cesarean delivery rate.Obstet Gynecol. 2011;118(1):29-38. doi: 10.1097/AOG.0b013e31821e5f65.

  5. Baicker K, Buckles KS, Chandra A. Geographic variation in the appropriate use of cesarean delivery.Health Aff (Millwood).2006;25(5):w355-w367.doi: 10.1377/hlthaff.25.w355.

  6. Main EK., Moore D, Farrell B. Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement. Am J Obstet Gynecol.2006;194(6):1644-1651.

  7. Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop.Obstet Gynecol.2012;120 (5):1181-1193.

  8. Neal JL, Lowe NK. Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset. Medical Hypotheses.2012;78(2), 319-326. doi: 10.1016/j.mehy.2011.11.012; 10.1016/j.mehy.2011.11.012.

  9. Neal JL, Lowe NK, Ahijevych KL, et al. "Active labor" duration and dilation rates among low-risk, nulliparous women with spontaneous labor onset: a systematic review.J Midwifery Womens Health.2010;55(4):308-318. doi: 10.1016/j.jmwh.2009.08.004.

  10. Zhang J, Landy HJ, Branch DW, et al. Contemporary patterns of spontaneous labor with normal neonatal outcomes.Obstet Gynecol.2010;116(6):1281-1287.



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