Contemporary labor patterns: The impact of maternal body mass index

Michelle A. Kominiarek*, Jun Zhang, Paul Vanveldhuisen, James Troendle, Julie Beaver, Judith U. Hibbard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

140 Scopus citations


Objective: We sought to compare labor patterns by body mass index (BMI). Study Design: A total of 118,978 gravidas with a singleton term cephalic gestation were studied. Repeated-measures analysis constructed mean labor curves by parity and BMI categories for those who reached 10 cm. Interval-censored regression analysis determined median traverse times, adjusting for covariates in vaginal deliveries and intrapartum cesareans. Results: In the labor curves, the time difference to reach 10 cm was 1.2 hours from the lowest to highest BMI category for nulliparas. Multiparas entered active phase by 6 cm, but reaching this point took longer for BMI <40.0 (3.4 hours) compared to BMI <25.0 (2.4 hours). Progression by centimeter (P <.001 for nulliparas) and from 4-10 cm (P <.001 for nulliparas and multiparas) increased as BMI increased. Second stage length, with and without an epidural, was similar among BMI categories for nulliparas (P >.05) but decreased as BMI increased for multiparas (P <.001). Conclusion: Labor proceeds more slowly as BMI increases, suggesting that labor management be altered to allow longer time for these differences.

Original languageEnglish (US)
Pages (from-to)244.e1-244.e8
JournalAmerican journal of obstetrics and gynecology
Issue number3
StatePublished - Sep 2011


  • body mass index
  • labor curves
  • obesity
  • pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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