“Constructing Centimeters: Emanuel Friedman’s Cervimeter and the Dilatation-Time Curve”
By: Rebecca Jackson, Indiana University--Bloomington
Due to high rates of caesarian sections in the US, there has been recent pushback against the use of cervical dilation thresholds for decisions during labor (ACOG & SMFM 2014; King and Pinger 2014). The professional organizations and practitioners pushing for reform have traced the historical misuse of dilation back to Emanuel A. Friedman and his eponymous curve of dilatation-over-time. By a careful examination of Friedman’s published papers (including some often overlooked), as well as an oral interview with Friedman, this paper shows that the story behind the Friedman Curve is more complex than appears, and does not start with Friedman at all. It starts with an eminent woman anesthesiologist (Virginia Apgar) with attention to laboring women’s needs, and the young junior physician she charged with finding answers for her (Friedman). This young man created a new dimension for measuring labor: change in dilatation rate over time, allowing the woman’s own body to participate in the definition of what it meant for labor to be “arrested.” Yet, in constructing a “normal” standard curve of dilatation-over-time for guiding labor decisions and constructing a “cervimeter” to be the (so-called) objective measuring instrument for evidencing the shape of this curve, he unintentionally enabled a new dimension of labor to emerge: centimeters of dilation, today read as the state of labor progress. This paper traces how Friedman’s cervimeter was constructed to evidence his claims about the “sigmoidal” shape of the dilatation curve, which was originally intended to test research claims about caudal anesthesia. The cervimeter effectively reified centimeters as an “objectively” measurable interval-scale unit (rather than representing an ordinal approximation felt by hand) and enabled the later transformation of Friedman’s Curve from a graphical tool which was meant to conform to women into a tool which was used to conform them.
Rebecca Jackson is a PhD Candidate in History and Philosophy of Science and Medicine at Indiana University - Bloomington, with particular interest in clinical measurement methodology and history and philosophy of measurement more broadly. She was awarded the 2021-2022 John C. Slater Predoctoral Fellowship, a 12-month residential Predoctoral Fellowship with the American Philosophical Society in Philadelphia, to conduct research for her dissertation, Measuring ‘Well’: Clinical Measuring Practices and Philosophy of Measurement. This dissertation focuses on four cases of successful patient-centric and non-standard clinical measuring practices from the 19th century to current debates.
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