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Objective: The objective of this study was to determine whether the duration and progress of the first stage of labor are different in black compared with white women., Study Design: Retrospective cohort study of labor progress among consecutive black (n = 3,924) and white (n = 921) women with singleton term pregnancies (≥ 37 weeks) who completed the first stage of labor. Duration of labor and progression from 1 cm to the next was estimated using interval-censored regression. Labor duration and progress among black and white women in the entire cohort, and stratified by parity, were compared in multivariable interval-censored regression models. Repeated-measures analysis with 9th-degree polynomial modeling was used to construct average labor curves., Results: There were no significant differences in duration of the first stage of labor in black compared with white women (median, 4-10 cm: 5.1 vs. 4.9 hours [p = 0.43] for nulliparous and 3.5 vs. 3.9 hours [p = 0.84] for multiparous women). Similarly, there were no significant differences in progression in increments of 1 cm. Average labor curves were also not significantly different., Conclusion: Duration and progress of the first stage of labor are identical in black and white women. This suggests similar standards may be applied in the first stage of labor., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Cesarean sections are the most common surgical procedure for women in the United States. Of the over 4 million births a year, one in three are now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode, precluding accurate generalizations. This study sought to assess the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in one academic medical center., Methods: A retrospective, cross-sectional cohort study was conducted of 4,483 nulliparous women with term, singleton, and vertex presentation deliveries at a major academic medical center between 2006-2011. Cases with medical conditions, risk factors, or pregnancy complications that can contribute to increased cesarean risk or contraindicate vaginal birth were excluded. Multinomial logistic regression analysis was used to evaluate differences in delivery mode and caesarean indications among racial and ethnic groups., Results: The overall rate of cesarean delivery in our cohort was 16.7%. Compared to White women, Black and Asian women had higher rates of cesarean delivery than spontaneous vaginal delivery, (adjusted odds ratio {AOR}: 1.43; 95% CI: 1.07, 1.91, and AOR: 1.49; 95% CI: 1.02, 2.17, respectively). Black women were also more likely, compared to White women, to undergo cesarean for fetal distress and indications diagnosed in the first stage as compared to the second stage of labor., Conclusions: Racial and ethnic differences in delivery mode and indications for cesareans exist among low-risk nulliparas at our institution. These differences may be best explained by examining the variation in clinical decisions that indicate fetal distress and failure to progress at the hospital-level.

Emanuel Friedman in the 1950s established means and statistical guidelines for normal lengths of labor. The childbearing population in the United States has changed considerably since Friedman's research was conducted. This study documented the duration of labor in a cohort of 240 Hispanic women who had normal vaginal births of singleton term infants from January 1995 through December 1998 and compared these results with the mean duration of the first and second stages of labor as established by Friedman. The mean duration of the active phase first stage labor duration for nulliparous Hispanic women was 6.2 hours, and for multiparous Hispanic women was 4.4 hours, both significantly longer than Friedman's group (P <.01). The mean duration of the second stage of labor in nulliparous Hispanic women was 54.2 minutes and for multiparous Hispanic women was 22.2 minutes, not significantly different from Friedman's group (P =.5 and P =.09, respectively).