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Emanuel Friedman (1926-)

Emanuel Friedman is a retired American obstetrician. He analysed thousands of women during labour in the 1950s, and from his statistics produced a graphical representation of an ‘ideal’ labour, which remains known as the Friedman curve. Supporters claim his work provided a stronger scientific foundation for childbirth. They say it allows physicians to make medical judgments reliant on something other than intuition. Critics argue his curve characterised the growing medicalisation of childbirth, where medical intervention was encouraged when the progress of a birth strayed from this idealised perception.

Friedman’s curve is a graph. Hours in labour are plotted against cervical dilation, measured in centimetres. Increasing dilation indicates the progress of the foetus as it moves down the birth canal. The curve is S-shaped. Friedman subdivided the first phase of labour from when labour starts to when the neck of the cervix dilates to 10 cm. At that point the second phase begins, during which the infant is delivered. Monitoring progress through the first phase against that expected by Friedman’s curve has directed clinical decisions such as whether to perform a Caesarean section.

The curve remains a feature of obstetrical training. However, its influence in the delivery room has decreased recently. There have also been calls to re-examine the criteria behind Friedman’s curve. This would take into account changes in both obstetrics and society since Friedman’s original work, such as the use of epidural anaesthesia and increases in average weights of mothers and infants.

 

Bibliography

E A Friedman, Labor: Clinical evaluation and management (New York: Appleton-Century-Crofts, 1978)

J Zhang et al. ‘Reassessing the labor curve in nulliparous women’, American Journal of Obstetrics and Gynecology, 187 (October 2002), pp 824-828

E van Teijlingen et al (eds.), Midwifery and the medicalization of childbirth: comparative perspectives (New York: Nova Science Publishers, Inc., 1999)

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