The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia, 2nd Edition

by Penny Simkin (BA, PT Private Practice of Expectant and New Parent Education, Seattle); Ruth Ancheta (ICCE, Perinatal and Human Sexuality Educator, Community Health Centre, Milwaukee)

• ISBN13: 9781405122177
• ISBN10: 140512217X
• Edition: 2nd
• Format: Paperback
• Copyright: 2005-10-01
• Publisher: Wiley-Blackwell

Summary

Dystocia or failure to progress in labor is the main reason for cesarean deliveries. The second edition of this successful text focuses on simple non-invasive interventions to prevent or treat difficult labor. It describes positions, movements and techniques based on principles of anatomy, physiology and psychology of childbirth. The Labor Progress Handbook is organized by stage of labor for easy reference, enabling the care giver to quickly identify appropriate low cost, low risk interventions and treat dystocia effectively, at an early stage before it becomes severe. The new edition has been thoroughly revised and updated and includes a new chapter on assessing progress in labor, together with new sections on managing labor pain, normal labor and additional positions and maneuvers. The rationale for all techniques is included based on the authors' clinical experience and wherever possible on the underlying evidence base. * New edition of essential resource for anyone caring for women in labor * Brings Together a wealth of evidence-based information and clinical expertise * 'Focuses on non-invasive techniques to assist the progress of labor * Emphasis on maternal comfort, support and safety * Encourages thoughtful, evidence-based diagnosis and intervention * Contains clear and simple illustrations, which complement the text From Reviews: 'The focus of support, position, maternal comfort, and safety is one that should be used by anyone caring for laboring women. It encourages thoughtful diagnosis and intervention in an ordered and sensible manner.' --Journal of Perinatal and Neonatal Nursing (on the first edition)

Author Biography

Penny Simkin serves on the Faculty and Board of Consultants of Seattle Midwifery School and is on the Editorial Board of Birth: Issues in Midwifery Care. She trains childbirth educators and doula trainers and is founder of Doulas of North America.

Ruth Ancheta has over 15 years experience in perinatal education and is an experienced doula and doula trainer.

Table of Contents

Foreword to the second edition	xi
Foreword to the first edition	xv
Dedication	xvii
Acknowledgements	xviii
Introduction	1	(10)
Some important differences in maternity care between the United States, the United Kingdom, and Canada	6	(1)
Notes on this book	6	(3)
Changes in this second edition	9	(1)
Material on epidurals	9	(1)
Conclusion	9	(1)
References	10	(1)
Dysfunctional Labor: General Considerations	11	(24)
What is normal labor?	11	(2)
What is dysfunctional labor?	13	(2)
Maintaining labor progress: prevention of dysfunctional labor	15	(1)
A role for the fetus in regulating labor?	16	(1)
The psycho-emotional state of the woman: reducing maternal distress	16	(6)
Psycho-emotional measures	18	(2)
Physical comfort measures	20	(1)
Physiological measures	21	(1)
Why focus on maternal position?	22	(1)
Monitoring the mobile woman's fetus	23	(8)
Auscultation	24	(1)
When electronic fetal monitoring is required: options to enhance maternal mobility	24	(1)
Continuous EFM	25	(2)
Intermittent EFM	27	(1)
Telemetry	28	(3)
Techniques to elicit stronger contractions	31	(1)
Conclusion	32	(1)
References	32	(3)
Assessing Progress in Labor	35	(47)
Before labor begins	36	(14)
Malposition	36	(2)
Observing for clues to fetal position	38	(1)
Palpating for fetal position	39	(1)
Palpating using Leopold's maneuvers	40	(3)
Auscultating for fetal position	43	(1)
Belly mapping	44	(4)
Other assessments prior to labor	48	(2)
Assessments during labor	50	(17)
Position, attitude and descent of the fetus	50	(1)
Vaginal examinations: indications and timing	51	(1)
Performing a vaginal examination during labor	51	(2)
The vaginal exam, step by step	53	(1)
Assessing the cervix	54	(1)
Unusual cervical findings	55	(1)
The presenting part	56	(8)
The vagina and bony pelvis	64	(1)
Quality of contractions	64	(3)
Assessing the mother's condition	67	(2)
Assessing the fetus	69	(6)
How to perform intermittent auscultation	70	(2)
Reassuring signs of fetal well-being that can be assessed without EFM	72	(3)
Putting it all together	75	(2)
Assessing progress in first stage	75	(1)
Features of normal latent phase	76	(1)
Features of normal active phase	76	(1)
Assessing progress in second stage	77	(1)
Features of normal second stage	77	(1)
Conclusion	77	(1)
References	77	(5)
Prolonged Pre-Labor and Latent First Stage	82	(21)
Is it dystocia?	82	(5)
When is a woman in labor?	83	(1)
Preventing the occiput posterior (OP): measures to use before labor	84	(3)
The woman who has hours of contractions without dilation	87	(1)
The six ways to progress in labor	87	(2)
Support measures for women who are at home in pre-labor and latent phase	89	(2)
Some reasons for excessive pain and duration of pre-labor or latent phase	91	(2)
Iatrogenic factors	91	(1)
Cervical factors	92	(1)
Fetal factors	92	(1)
Emotional factors	92	(1)
Troubleshooting measures for painful prolonged pre-labor or latent phase	93	(2)
Measures to alleviate painful irregular non-dilating contractions in pre-labor or latent phase	95	(1)
Synclitism and asynclitism	95	(6)
Conclusion	101	(1)
References	101	(2)
Prolonged Active Phase of Labor	103	(43)
What is prolonged active labor?	104	(1)
Characteristics of prolonged active labor	105	(1)
Possible causes of prolonged active labor	106	(6)
Fetal and feto-pelvic factors	108	(2)
Why fetal malpositions delay labor progress	110	(1)
Artificial rupture of the membranes (AROM) with a malpositioned fetus	111	(1)
Specific measures to address and correct problems associated with malposition, cephalo-pelvic disproportion and macrosomia	112	(1)
Maternal positions and movements for suspected malposition, cephalo-pelvic disproportion, or macrosomia in active labor	112	(11)
Forward-leaning positions	114	(2)
Side-lying positions	116	(2)
Asymmetrical positions and movements	118	(2)
Abdominal lifting	120	(1)
An uncontrollable premature urge to push	120	(3)
If contractions are inadequate	123	(8)
Immobility	123	(2)
Medication	125	(1)
Dehydration	126	(1)
Exhaustion	126	(1)
Uterine lactic acidosis as a cause of inadequate contractions	127	(1)
When the cause of inadequate contractions is unknown	128	(3)
If there is a persistent cervical lip or a swollen cervix	131	(2)
Position changes to reduce an anterior lip or a swollen cervix	132	(1)
Other methods	132	(1)
Manual reduction of a persistent cervical lip	133	(1)
If emotional dystocia is suspected	134	(8)
Assessing the woman's coping	134	(2)
Indicators of emotional dystocia during active labor	136	(1)
Predisposing factors for emotional dystocia	136	(1)
Helping the woman state her fears	137	(1)
How to help a laboring woman in distress	138	(2)
Special needs of childhood abuse survivors	140	(1)
Incompatibility or poor relationship with staff	141	(1)
If the source of the woman's anxiety cannot be identified	142	(1)
Conclusion	142	(1)
References	143	(3)
Prolonged Second Stage of Labor	146	(50)
Definitions of the second stage of labor	146	(1)
The phases of the second stage	147	(15)
The latent phase of the second stage	147	(3)
The active phase of the second stage	150	(6)
If the woman has an epidural	156	(5)
How long an active phase of second stage is too long?	161	(1)
Possible etiologies and solutions for second-stage dystocia	162	(30)
Positions and other strategies for suspected occiput posterior (OP) or persistent occiput transverse (OT) fetuses	162	(1)
Why not the dorsal position?	162	(3)
Differentiating between pushing positions and birth positions	165	(9)
Manual interventions to reposition the OP fetus	174	(1)
Early interventions for suspected persistent asynclitism	174	(3)
If cephalo-pelvic disproportion (CPD) or macrosomia is suspected	177	(1)
Positions for 'possible CPD' in second stage	178	(10)
Shoulder dystocia	188	(1)
If contractions are inadequate	188	(1)
If emotional dystocia is suspected	188	(4)
Conclusion	192	(1)
References	193	(3)
The Labor Progress Toolkit: Part 1. Maternal Positions and Movements	196	(50)
Maternal positions	197	(34)
Side-lying positions	198	(4)
The 'side-lying lunge'	202	(1)
Semi-sitting	203	(2)
Sitting upright	205	(2)
Sitting leaning forward with support	207	(1)
Standing, leaning forward	208	(2)
Kneeling, leaning forward with support	210	(2)
Hands and knees	212	(1)
Open knee-chest position	213	(2)
Closed knee-chest position	215	(1)
Asymmetrical upright (standing, kneeling, sitting) positions	216	(2)
Squatting	218	(2)
Supported squatting positions	220	(2)
Half squatting, lunging and swaying	222	(2)
Lap squatting	224	(2)
Exaggerated lithotomy (McRoberts' position)	226	(2)
Supine	228	(1)
Rope pull	229	(2)
Maternal movements	231	(13)
Pelvic rocking (also called pelvic tilt) and other movements of the pelvis	231	(2)
The lunge	233	(2)
Walking or stair climbing	235	(1)
Slow dancing	236	(2)
Abdominal stroking	238	(1)
Abdominal lifting	239	(2)
The pelvic press	241	(2)
Other rhythmic movements	243	(1)
References	244	(2)
The Labor Progress Toolkit: Part 2. Comfort Measures	246	(44)
General guidelines for comfort during a slow labor	247	(1)
Non-pharmacological physical comfort measures	248	(17)
Heat	248	(2)
Cold	250	(2)
Hydrotherapy	252	(5)
Touch and massage	257	(2)
Acupressure	259	(1)
Acupuncture	260	(2)
Continuous labor support from a doula, nurse, or midwife	262	(3)
Psychosocial comfort measures	265	(3)
Assessing the woman's emotional state	265	(3)
Techniques and devices to reduce back pain	268	(15)
Counter-pressure	268	(1)
The double hip squeeze	269	(3)
The knee press	272	(1)
Cold and heat	273	(2)
Hydrotherapy	275	(1)
Movement	276	(1)
Birth ball	277	(1)
Transcutaneous electrical nerve stimulation (TENS)	278	(3)
Intradermal sterile water injections for back pain (ID water blocks)	281	(2)
Breathing for relaxation and a sense of mastery	283	(2)
Bearing-down techniques for the second stage	285	(2)
Conclusion	287	(1)
References	287	(3)
Epidural Index	290	(1)
Index	291