The Labor Progress Handbook
Early Interventions to Prevent and Treat Dystocia
4th Edition
Published on 21. April 2017
Book
Paperback/Softback
416 pages
978-1-119-17046-4 (ISBN)
Description
Praise for the previous edition:
"This...edition is timely, useful, well organized, and should be in the bags of all doulas, nurses, midwives, physicians, and students involved in childbirth."
-Journal of Midwifery and Women's Health
The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia is an unparalleled resource on simple, non-invasive interventions to prevent or treat difficult or prolonged labor. Thoroughly updated and highly illustrated, the book shows how to tailor one's care to the suspected etiology of the problem, using the least complex interventions first, followed by more complex interventions if necessary.
This new edition now includes a new chapter on reducing dystocia in labors with epidurals, new material on the microbiome, as well as information on new counselling approaches specially designed for midwives to assist those who have had traumatic childbirths.
Fully referenced and full of practical instructions throughout, The Labor Progress Handbook continues to be an indispensable guide for novices and experts alike who will benefit from its concise and accessible content.
"This...edition is timely, useful, well organized, and should be in the bags of all doulas, nurses, midwives, physicians, and students involved in childbirth."
-Journal of Midwifery and Women's Health
The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia is an unparalleled resource on simple, non-invasive interventions to prevent or treat difficult or prolonged labor. Thoroughly updated and highly illustrated, the book shows how to tailor one's care to the suspected etiology of the problem, using the least complex interventions first, followed by more complex interventions if necessary.
This new edition now includes a new chapter on reducing dystocia in labors with epidurals, new material on the microbiome, as well as information on new counselling approaches specially designed for midwives to assist those who have had traumatic childbirths.
Fully referenced and full of practical instructions throughout, The Labor Progress Handbook continues to be an indispensable guide for novices and experts alike who will benefit from its concise and accessible content.
More details
Edition
4th edition
Language
English
Place of publication
Hoboken
United Kingdom
Publishing group
John Wiley and Sons Ltd
Target group
Professional and scholarly
Dimensions
Height: 213 mm
Width: 140 mm
Thickness: 18 mm
Weight
408 gr
ISBN-13
978-1-119-17046-4 (9781119170464)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
Schweitzer Classification
Other editions
New editions
Lisa Hanson | Penny Simkin | Ruth Ancheta
Simkin's Labor Progress Handbook
Early Interventions to Prevent and Treat Dystocia
Book
01/2024
5th Edition
Wiley-Blackwell
€58.50
Shipment within 15-20 days
Additional editions
Penny Simkin | Lisa Hanson | Ruth Ancheta
The Labor Progress Handbook
Early Interventions to Prevent and Treat Dystocia
E-Book
04/2017
4th Edition
Wiley-Blackwell
€46.99
Available for download
Penny Simkin | Lisa Hanson | Ruth Ancheta
The Labor Progress Handbook
Early Interventions to Prevent and Treat Dystocia
E-Book
02/2017
4th Edition
Wiley-Blackwell
€46.99
Available for download
Previous edition
Penny Simkin | Ruth Ancheta
The Labor Progress Handbook
Early Interventions to Prevent and Treat Dystocia
Book
03/2011
3rd Edition
Wiley-Blackwell
€39.90
Article exhausted; check for reprint
Persons
Penny Simkin, Senior Faculty at Simkin Center for Allied Birth, Vocations at Bastyr University, Independent Practice of Childbirth Education and Labor Support, USA.
Lisa Hanson, Professor and Director, Midwifery Program, College of Nursing, Marquette University, USA.
Ruth Ancheta, DONA-Approved Doula Trainer, Independent Practice of Childbirth Education and Labor Support, USA.
Lisa Hanson, Professor and Director, Midwifery Program, College of Nursing, Marquette University, USA.
Ruth Ancheta, DONA-Approved Doula Trainer, Independent Practice of Childbirth Education and Labor Support, USA.
Content
Foreword to the Fourth Edition xvii
Acknowledgments xx
Chapter 1: Introduction 1
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
Causes and prevention of labor dystocia: a systematic approach 1
Differences in maternity care providers and practices in the united kingdom, the united states, and canada 5
Notes on this book 5
Changes in this fourth edition 6
A note from the authors on the use of gender-specific language 6
Conclusion 7
References 7
Chapter 2: Normal Labor and Labor Dystocia: General Considerations 9
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
What is normal labor? 10
What is labor dystocia? 14
Why does labor progress slow down or stop? 15
Prostaglandins and hormonal influences on emotions and labor progress 17
"Fight-or-flight" and "tend-and-befriend" responses to distress and fear during labor 19
Optimizing the environment for birth 21
The psycho-emotional state of the woman: wellbeing or distress? 21
Pain versus suffering 21
Assessment of pain and distress in labor 22
Assessment of women's ability to cope with the pain 23
Psycho-emotional measures to reduce suffering, fear, and anxiety 24
Before labor, what the caregiver can do 24
During labor: tips for caregivers and doulas, especially if meeting the laboring client for the first time in labor 26
An integrated philosophy on caring for trauma survivors 27
Trauma histories: why they matter 27
Childhood sexual abuse (CSA) and trauma in adulthood 27
Traumatic births 28
Trauma-informed care as a universal precaution 31
Physical and physiologic measures to promote comfort and labor progress 32
During labor: physical comfort measures 32
During labor: physiologic measures 32
Why focus on maternal position? 33
Techniques to elicit stronger contractions 35
Maintaining maternal mobility while monitoring contractions and fetal heart 36
Auscultation 36
When EFM is required: options to enhance maternal mobility 37
Continuous EFM 37
Intermittent EFM 39
Wireless telemetry 40
Conclusion 42
References 42
Chapter 3: Assessing Progress in Labor 49
Wendy Gordon, LM, CPM, MPH, Suzy Myers, LM, CPM, MPH, with contributions by Gail Tully, BS, CPM, CD(DONA) and Lisa Hanson, PhD, CNM, FACNM
Before labor begins 50
Fetal presentation and position 50
Abdominal contour 52
Location of the point of maximum intensity (PMI) of the fetal heart tones via auscultation 53
Leopold's maneuvers for identifying fetal presentation and position 55
Abdominal palpation using Leopold's maneuvers 55
Estimating engagement 58
Malposition 62
Influencing fetal position prior to labor 62
Identifying those fetuses likely to persist in an OP position throughout labor 63
Influencing fetal position during labor 63
Other assessments prior to labor 64
Estimating fetal weight 64
Assessing the cervix prior to labor 64
The Bishop scoring system 65
Assessments during labor 66
Visual and verbal assessments 66
Hydration and nourishment 66
Psychology 67
Quality of contractions 68
External assessments 69
Vital signs 69
Quality of contractions 69
Abdominal palpation (Leopold's maneuvers) 70
Assessing the fetus 70
Gestational age 71
Meconium 71
Fetal heart rate (FHR) 71
Internal assessments 75
Vaginal examinations: indications and timing 77
Performing a vaginal examination during labor 77
Assessing the cervix 79
Assessing the presenting part 81
The vagina and bony pelvis 87
Putting it all together 87
Assessing progress in the first stage 87
Features of normal latent phase 88
Features of normal active phase 88
Assessing progress in the second stage 88
Features of normal second stage 88
Conclusion 89
References 89
Chapter 4: Prolonged Prelabor and Latent First Stage 95
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
The onset of labor: key elements in diagnosis 96
Prelabor vs labor: the dilemma for expectant parents 96
Symptoms that differentiate prelabor from early labor 97
The six ways to progress in labor-prelabor to birth 99
The Bishop Score 100
Use of the "Six Ways to Progress" and the Bishop Score to help parents differentiate prelabor from labor 100
Prolonged prelabor and latent phase of labor 101
Can prenatal actions prevent some postdates pregnancies, prolonged prelabors, or early labors? 102
Prenatal preparation of the cervix for dilation 102
Attention to fetal factors that may prolong early labor 107
Optimal fetal positioning: prenatal features 107
Prenatal assessment and correction of suboptimal maternal musculoskeletal variations 109
The woman who has hours of latent labor contractions without dilation 109
Support measures for women who are at home in prelabor and the latent phase 109
Some reasons for excessive pain and duration of prelabor or the latent phase 112
Iatrogenic factors 112
Cervical factors 112
Other soft tissue (ligaments, muscles, fascia) factors 113
Emotional factors 113
Troubleshooting measures for painful prolonged prelabor or latent phase 114
Measures to alleviate painful, non-progressing, non-dilating contractions in prelabor or the latent phase 115
Synclitism and asynclitism 116
Open knee-chest position 119
Closed knee-chest position 120
Side-lying release 120
Conclusion 121
References 121
Chapter 5 Prolonged Active Phase of Labor 125
Penny Simkin, BA, PT, CCE, CD(DONA), Ruth Ancheta, MA, ICCE, CD(DONA), and Lisa Hanson, PhD, CNM, FACNM
What is active labor? Description, definition, diagnosis 126
When is active labor prolonged? 127
Observable characteristics of prolonged active labor 127
Possible causes of prolonged active labor 128
Fetal and fetopelvic factors 129
Malposition, macrosomia, malpresentation, and cephalopelvic disproportion 129
Persistent asynclitism 130
Occiput posterior 130
How fetal malpositions delay labor progress 132
Problems in diagnosis of fetal position during labor 133
Artificial rupture of the membranes with a malpositioned fetus 134
Specific measures to address and correct problems associated with a "poor fit"-malposition, cephalopelvic disproportion, and macrosomia 135
Maternal positions and movements for suspected malposition, cephalopelvic disproportion, or macrosomia 135
Forward-leaning positions 136
Side-lying positions 138
Asymmetrical positions and movements 140
Abdominal lifting 142
An uncontrollable premature urge to push 143
If contractions are inadequate 145
Immobility 145
Medication 147
Dehydration and fear of dehydration 147
Overhydration-excessive oral and/or intravenous fluids 148
Exhaustion 149
Uterine lactic acidosis as a cause of inadequate contractions 149
When the cause of inadequate contractions is unknown 150
Breast stimulation 150
Walking and changes in position 151
Acupressure or acupuncture 151
Hydrotherapy (baths and showers) 151
If there is a persistent anterior cervical lip or a swollen cervix 153
Positions to reduce an anterior cervical lip or a swollen cervix 153
Other methods 154
Manual reduction of a persistent cervical lip 155
If emotional dystocia is suspected 155
Assessing the woman's coping 155
Western cultural attitudes on coping with labor 155
Relaxation, Rhythm, and Ritual: The essence of "coping" during the first stage of labor 155
Indicators of emotional dystocia during active labor 156
Predisposing factors for emotional dystocia 157
Helping the woman state her fears 157
How to help a laboring woman in distress 158
Special needs of childhood abuse survivors 159
Incompatibility or poor relationship with staff 161
If the source of the woman's anxiety cannot be identified 161
Conclusion 162
References 162
Chapter 6 Prevention and Treatment of Prolonged Second Stage of Labor 167
Penny Simkin, BA, PT, CCE, CD(DONA), Lisa Hanson, PhD, CNM, FACNM, and Ruth Ancheta, MA, ICCE, CD(DONA)
Definitions of the second stage of labor 168
Phases of the second stage of labor 168
The latent phase of the second stage 169
Avoid directing the woman to push during the latent phase of the second stage 170
What if the latent phase of the second stage persists? 171
The active phase of the second stage 171
Support of spontaneous bearing down 171
Physiologic effects of prolonged breath-holding and straining 172
Effects on the woman 172
Effects on the fetus 172
Spontaneous expulsive efforts 172
Diffuse pushing 174
Second stage time limits 175
Possible etiologies and solutions for second stage dystocia 176
Maternal positions and other strategies for suspected occiput posterior or persistent occiput transverse fetuses 178
Why not the supine position? 179
Differentiating between pushing positions and birth positions 179
Leaning forward while kneeling, standing, or sitting 179
Squatting positions 179
Asymmetrical positions 179
Lateral positions 182
Supported squat or "dangle" positions 183
Other strategies for malposition and back pain 183
Manual interventions to reposition the occiput posterior fetus 187
Early interventions for suspected persistent asynclitism 190
Positions and movements for persistent asynclitism in second stage 192
Nuchal hand or hands at vertex delivery 193
If cephalopelvic disproportion or macrosomia ("poor fit") is suspected 193
The influence of time on cephalopelvic disproportion 194
Fetal head descent 194
Positions for suspected "cephalopelvic disproportion" (CPD) in second stage 194
The use of supine positions 200
Use of the exaggerated lithotomy position 202
Shoulder dystocia 203
If contractions are inadequate 203
If emotional dystocia is suspected 204
The essence of coping during the second stage of labor 204
Signs of emotional distress in second stage 205
Triggers of emotional distress unique to the second stage 205
Conclusion 207
References 207
Chapter 7 Optimal Newborn Transition and Third and Fourth Stage Labor Management 211
Lisa Hanson, PhD, CNM, FACNM, and Penny Simkin, BA, PT, CCE, CD(DONA)
Overview of the normal third and fourth stages of labor for unmedicated mother and baby 211
Third stage management: care of the baby 213
Oral and nasopharynx suctioning 213
Delayed clamping and cutting of the umbilical cord 214
Management of delivery of an infant with a tight nuchal cord 216
Third stage management: the placenta 216
Physiologic (expectant) management of the third stage of labor 217
Active management of the third stage of labor 218
The fourth stage of labor 221
Keeping the mother and baby together 221
Baby-friendly (breastfeeding) practices 222
Supporting microbial health of the infant 223
Routine newborn assessments 225
Conclusion 226
References 227
Chapter 8 Low-Technology Clinical Interventions to Promote Labor Progress 231
Lisa Hanson, PhD, CNM, FACNM
Intermediate-level interventions for management of problem labors 232
When progress in prelabor or latent phase remains inadequate 232
Therapeutic rest 232
Nipple stimulation 233
Management of cervical stenosis or the "zipper" cervix 233
When progress in active phase remains inadequate 234
Artificial rupture of the membranes (AROM) 234
Digital or manual rotation of the fetal head 235
Digital rotation 236
Manual rotation 237
Manual reduction of a persistent cervical lip 238
Reducing swelling of the cervix or anterior lip 238
Fostering normality in birth 239
Perineal management 239
Prenatal perineal massage 239
Perineal management during second stage 240
Verbal support of spontaneous bearing-down efforts 240
Maternal birth positions 241
Guiding women through crowning of the fetal head 241
Hand skills to protect the perineum 242
Differentiating perineal massage from other interventions 243
When progress in second stage labor remains inadequate 243
Duration of second stage labor 243
Precautionary measures 245
Warning signs 246
Shoulder dystocia maneuvers 246
The McRoberts' maneuver 247
Suprapubic pressure 248
The Gaskin maneuver 249
Somersault maneuver 249
Non-pharmacologic and minimally invasive pharmacologic techniques for intrapartum pain relief 251
Acupuncture 251
Sterile Water Injections 252
Procedure for subcutaneous sterile water injections 253
Nitrous oxide 254
Topical anesthetic applied to the perineum 254
Conclusion 254
References 255
Chapter 9 Epidural and Other Forms of Neuraxial Analgesia for Labor: Review of Effects, with Emphasis on Preventing Dystocia 260
Penny Simkin, BA, PT, CCE, CD(DONA)
Introduction: analgesia and anesthesia-an integral part of maternity care in many countries 261
Neuraxial (epidural and spinal) analgesia-new terms for old approaches to labor pain? 261
Physiological adjustments that support fetal growth and wellbeing 262
Multisystem effects of epidural analgesia on labor progress 263
The endocrine system 263
The central nervous system and peripheral nervous system (sensory, motor, and autonomic, including the sympathetic and parasympathetic nervous systems) 264
The musculoskeletal system 265
The genitourinary system 266
Can changes in labor management reduce problems of epidural analgesia? 266
1. Inform the woman ahead of time 266
2. Shorten the duration of exposure 267
3. Treat the woman as much as possible like a person who does not have an epidural 267
4. Attend to the woman's emotional needs 272
Restoring women to a central role 273
Conclusion 274
References 274
Chapter 10 The Labor Progress Toolkit
Part 1: Positions and Movements 277
Penny Simkin BA, PT, CCE, CD(DONA) and Ruth Ancheta MA, ICCE, CD(DONA)
Maternal positions and how they affect labor 278
Side-lying positions 279
Pure side-lying and semiprone (exaggerated Sims') 279
The "semiprone lunge" 284
Side-lying release 285
Sitting positions 288
Semisitting 288
Sitting upright 289
Sitting leaning forward with support 290
Standing, leaning forward 292
Kneeling positions 293
Kneeling, leaning forward with support 293
Hands and knees 295
Open knee-chest position 296
Closed knee-chest position 298
Asymmetrical upright (standing, kneeling, sitting) positions 299
Squatting positions 300
Squatting 300
Supported squatting ("dangling") positions 302
Half-squatting, lunging, and swaying 304
Lap squatting 306
Supine positions 308
Supine 308
Sheet"pull-to-push"309
Exaggerated lithotomy (McRoberts' position) 310
Maternal movements in first and second stages 312
Pelvic rocking (also called pelvic tilt) and other movements of the pelvis 312
Hip sifting 314
Flexion of hips and knees in hands and knees position 315
The lunge 316
Walking or stair climbing 317
Slow dancing 318
Abdominal lifting 320
Abdominal jiggling with a rebozo 321
The pelvic press 323
Other rhythmic movements 324
References 326
Chapter 11 The Labor Progress Toolkit
Part 2: Comfort Measures 327
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
Introduction: the state of the science regarding non-pharmacologic, complementary, and alternative methods to relieve labor pain 328
General guidelines for comfort during a slow labor 328
Non-pharmacologic methods to relieve labor pain 328
Non-pharmacologic physical comfort measures 330
Heat 330
Cold 331
Hydrotherapy 333
Touch and massage 337
How to give simple brief massages for shoulders and back, hands, and feet 338
Acupressure 343
Acupuncture 344
Continuous labor support from a doula, nurse, or midwife 345
How the doula helps 345
What about staff nurses and midwives as labor support providers? 346
Psychosocial comfort measures 347
Assessing the woman's emotional state 348
Techniques and devices to reduce back pain 350
Counterpressure 350
The double hip squeeze 351
The knee press 353
Cook's counterpressure technique No. 1: ischial tuberosities (IT) 354
Cook's counterpressure technique No. 2: perilabial pressure 355
Techniques and devices to reduce back pain 357
Cold and heat 357
Cold and rolling cold 358
Warm compresses 359
Hydrotherapy 359
Maternal movement and positions 360
Birth ball 360
Transcutaneous electrical nerve stimulation (TENS) 362
Sterile water injections for back pain 364
Breathing for relaxation and a sense of mastery 364
Simple breathing rhythms to teach on the spot in labor 365
Bearing-down techniques for the second stage 366
Spontaneous bearing down (pushing) 366
Self-directed pushing 367
Directed pushing 367
Conclusion 367
References 368
Index 371
Acknowledgments xx
Chapter 1: Introduction 1
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
Causes and prevention of labor dystocia: a systematic approach 1
Differences in maternity care providers and practices in the united kingdom, the united states, and canada 5
Notes on this book 5
Changes in this fourth edition 6
A note from the authors on the use of gender-specific language 6
Conclusion 7
References 7
Chapter 2: Normal Labor and Labor Dystocia: General Considerations 9
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
What is normal labor? 10
What is labor dystocia? 14
Why does labor progress slow down or stop? 15
Prostaglandins and hormonal influences on emotions and labor progress 17
"Fight-or-flight" and "tend-and-befriend" responses to distress and fear during labor 19
Optimizing the environment for birth 21
The psycho-emotional state of the woman: wellbeing or distress? 21
Pain versus suffering 21
Assessment of pain and distress in labor 22
Assessment of women's ability to cope with the pain 23
Psycho-emotional measures to reduce suffering, fear, and anxiety 24
Before labor, what the caregiver can do 24
During labor: tips for caregivers and doulas, especially if meeting the laboring client for the first time in labor 26
An integrated philosophy on caring for trauma survivors 27
Trauma histories: why they matter 27
Childhood sexual abuse (CSA) and trauma in adulthood 27
Traumatic births 28
Trauma-informed care as a universal precaution 31
Physical and physiologic measures to promote comfort and labor progress 32
During labor: physical comfort measures 32
During labor: physiologic measures 32
Why focus on maternal position? 33
Techniques to elicit stronger contractions 35
Maintaining maternal mobility while monitoring contractions and fetal heart 36
Auscultation 36
When EFM is required: options to enhance maternal mobility 37
Continuous EFM 37
Intermittent EFM 39
Wireless telemetry 40
Conclusion 42
References 42
Chapter 3: Assessing Progress in Labor 49
Wendy Gordon, LM, CPM, MPH, Suzy Myers, LM, CPM, MPH, with contributions by Gail Tully, BS, CPM, CD(DONA) and Lisa Hanson, PhD, CNM, FACNM
Before labor begins 50
Fetal presentation and position 50
Abdominal contour 52
Location of the point of maximum intensity (PMI) of the fetal heart tones via auscultation 53
Leopold's maneuvers for identifying fetal presentation and position 55
Abdominal palpation using Leopold's maneuvers 55
Estimating engagement 58
Malposition 62
Influencing fetal position prior to labor 62
Identifying those fetuses likely to persist in an OP position throughout labor 63
Influencing fetal position during labor 63
Other assessments prior to labor 64
Estimating fetal weight 64
Assessing the cervix prior to labor 64
The Bishop scoring system 65
Assessments during labor 66
Visual and verbal assessments 66
Hydration and nourishment 66
Psychology 67
Quality of contractions 68
External assessments 69
Vital signs 69
Quality of contractions 69
Abdominal palpation (Leopold's maneuvers) 70
Assessing the fetus 70
Gestational age 71
Meconium 71
Fetal heart rate (FHR) 71
Internal assessments 75
Vaginal examinations: indications and timing 77
Performing a vaginal examination during labor 77
Assessing the cervix 79
Assessing the presenting part 81
The vagina and bony pelvis 87
Putting it all together 87
Assessing progress in the first stage 87
Features of normal latent phase 88
Features of normal active phase 88
Assessing progress in the second stage 88
Features of normal second stage 88
Conclusion 89
References 89
Chapter 4: Prolonged Prelabor and Latent First Stage 95
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
The onset of labor: key elements in diagnosis 96
Prelabor vs labor: the dilemma for expectant parents 96
Symptoms that differentiate prelabor from early labor 97
The six ways to progress in labor-prelabor to birth 99
The Bishop Score 100
Use of the "Six Ways to Progress" and the Bishop Score to help parents differentiate prelabor from labor 100
Prolonged prelabor and latent phase of labor 101
Can prenatal actions prevent some postdates pregnancies, prolonged prelabors, or early labors? 102
Prenatal preparation of the cervix for dilation 102
Attention to fetal factors that may prolong early labor 107
Optimal fetal positioning: prenatal features 107
Prenatal assessment and correction of suboptimal maternal musculoskeletal variations 109
The woman who has hours of latent labor contractions without dilation 109
Support measures for women who are at home in prelabor and the latent phase 109
Some reasons for excessive pain and duration of prelabor or the latent phase 112
Iatrogenic factors 112
Cervical factors 112
Other soft tissue (ligaments, muscles, fascia) factors 113
Emotional factors 113
Troubleshooting measures for painful prolonged prelabor or latent phase 114
Measures to alleviate painful, non-progressing, non-dilating contractions in prelabor or the latent phase 115
Synclitism and asynclitism 116
Open knee-chest position 119
Closed knee-chest position 120
Side-lying release 120
Conclusion 121
References 121
Chapter 5 Prolonged Active Phase of Labor 125
Penny Simkin, BA, PT, CCE, CD(DONA), Ruth Ancheta, MA, ICCE, CD(DONA), and Lisa Hanson, PhD, CNM, FACNM
What is active labor? Description, definition, diagnosis 126
When is active labor prolonged? 127
Observable characteristics of prolonged active labor 127
Possible causes of prolonged active labor 128
Fetal and fetopelvic factors 129
Malposition, macrosomia, malpresentation, and cephalopelvic disproportion 129
Persistent asynclitism 130
Occiput posterior 130
How fetal malpositions delay labor progress 132
Problems in diagnosis of fetal position during labor 133
Artificial rupture of the membranes with a malpositioned fetus 134
Specific measures to address and correct problems associated with a "poor fit"-malposition, cephalopelvic disproportion, and macrosomia 135
Maternal positions and movements for suspected malposition, cephalopelvic disproportion, or macrosomia 135
Forward-leaning positions 136
Side-lying positions 138
Asymmetrical positions and movements 140
Abdominal lifting 142
An uncontrollable premature urge to push 143
If contractions are inadequate 145
Immobility 145
Medication 147
Dehydration and fear of dehydration 147
Overhydration-excessive oral and/or intravenous fluids 148
Exhaustion 149
Uterine lactic acidosis as a cause of inadequate contractions 149
When the cause of inadequate contractions is unknown 150
Breast stimulation 150
Walking and changes in position 151
Acupressure or acupuncture 151
Hydrotherapy (baths and showers) 151
If there is a persistent anterior cervical lip or a swollen cervix 153
Positions to reduce an anterior cervical lip or a swollen cervix 153
Other methods 154
Manual reduction of a persistent cervical lip 155
If emotional dystocia is suspected 155
Assessing the woman's coping 155
Western cultural attitudes on coping with labor 155
Relaxation, Rhythm, and Ritual: The essence of "coping" during the first stage of labor 155
Indicators of emotional dystocia during active labor 156
Predisposing factors for emotional dystocia 157
Helping the woman state her fears 157
How to help a laboring woman in distress 158
Special needs of childhood abuse survivors 159
Incompatibility or poor relationship with staff 161
If the source of the woman's anxiety cannot be identified 161
Conclusion 162
References 162
Chapter 6 Prevention and Treatment of Prolonged Second Stage of Labor 167
Penny Simkin, BA, PT, CCE, CD(DONA), Lisa Hanson, PhD, CNM, FACNM, and Ruth Ancheta, MA, ICCE, CD(DONA)
Definitions of the second stage of labor 168
Phases of the second stage of labor 168
The latent phase of the second stage 169
Avoid directing the woman to push during the latent phase of the second stage 170
What if the latent phase of the second stage persists? 171
The active phase of the second stage 171
Support of spontaneous bearing down 171
Physiologic effects of prolonged breath-holding and straining 172
Effects on the woman 172
Effects on the fetus 172
Spontaneous expulsive efforts 172
Diffuse pushing 174
Second stage time limits 175
Possible etiologies and solutions for second stage dystocia 176
Maternal positions and other strategies for suspected occiput posterior or persistent occiput transverse fetuses 178
Why not the supine position? 179
Differentiating between pushing positions and birth positions 179
Leaning forward while kneeling, standing, or sitting 179
Squatting positions 179
Asymmetrical positions 179
Lateral positions 182
Supported squat or "dangle" positions 183
Other strategies for malposition and back pain 183
Manual interventions to reposition the occiput posterior fetus 187
Early interventions for suspected persistent asynclitism 190
Positions and movements for persistent asynclitism in second stage 192
Nuchal hand or hands at vertex delivery 193
If cephalopelvic disproportion or macrosomia ("poor fit") is suspected 193
The influence of time on cephalopelvic disproportion 194
Fetal head descent 194
Positions for suspected "cephalopelvic disproportion" (CPD) in second stage 194
The use of supine positions 200
Use of the exaggerated lithotomy position 202
Shoulder dystocia 203
If contractions are inadequate 203
If emotional dystocia is suspected 204
The essence of coping during the second stage of labor 204
Signs of emotional distress in second stage 205
Triggers of emotional distress unique to the second stage 205
Conclusion 207
References 207
Chapter 7 Optimal Newborn Transition and Third and Fourth Stage Labor Management 211
Lisa Hanson, PhD, CNM, FACNM, and Penny Simkin, BA, PT, CCE, CD(DONA)
Overview of the normal third and fourth stages of labor for unmedicated mother and baby 211
Third stage management: care of the baby 213
Oral and nasopharynx suctioning 213
Delayed clamping and cutting of the umbilical cord 214
Management of delivery of an infant with a tight nuchal cord 216
Third stage management: the placenta 216
Physiologic (expectant) management of the third stage of labor 217
Active management of the third stage of labor 218
The fourth stage of labor 221
Keeping the mother and baby together 221
Baby-friendly (breastfeeding) practices 222
Supporting microbial health of the infant 223
Routine newborn assessments 225
Conclusion 226
References 227
Chapter 8 Low-Technology Clinical Interventions to Promote Labor Progress 231
Lisa Hanson, PhD, CNM, FACNM
Intermediate-level interventions for management of problem labors 232
When progress in prelabor or latent phase remains inadequate 232
Therapeutic rest 232
Nipple stimulation 233
Management of cervical stenosis or the "zipper" cervix 233
When progress in active phase remains inadequate 234
Artificial rupture of the membranes (AROM) 234
Digital or manual rotation of the fetal head 235
Digital rotation 236
Manual rotation 237
Manual reduction of a persistent cervical lip 238
Reducing swelling of the cervix or anterior lip 238
Fostering normality in birth 239
Perineal management 239
Prenatal perineal massage 239
Perineal management during second stage 240
Verbal support of spontaneous bearing-down efforts 240
Maternal birth positions 241
Guiding women through crowning of the fetal head 241
Hand skills to protect the perineum 242
Differentiating perineal massage from other interventions 243
When progress in second stage labor remains inadequate 243
Duration of second stage labor 243
Precautionary measures 245
Warning signs 246
Shoulder dystocia maneuvers 246
The McRoberts' maneuver 247
Suprapubic pressure 248
The Gaskin maneuver 249
Somersault maneuver 249
Non-pharmacologic and minimally invasive pharmacologic techniques for intrapartum pain relief 251
Acupuncture 251
Sterile Water Injections 252
Procedure for subcutaneous sterile water injections 253
Nitrous oxide 254
Topical anesthetic applied to the perineum 254
Conclusion 254
References 255
Chapter 9 Epidural and Other Forms of Neuraxial Analgesia for Labor: Review of Effects, with Emphasis on Preventing Dystocia 260
Penny Simkin, BA, PT, CCE, CD(DONA)
Introduction: analgesia and anesthesia-an integral part of maternity care in many countries 261
Neuraxial (epidural and spinal) analgesia-new terms for old approaches to labor pain? 261
Physiological adjustments that support fetal growth and wellbeing 262
Multisystem effects of epidural analgesia on labor progress 263
The endocrine system 263
The central nervous system and peripheral nervous system (sensory, motor, and autonomic, including the sympathetic and parasympathetic nervous systems) 264
The musculoskeletal system 265
The genitourinary system 266
Can changes in labor management reduce problems of epidural analgesia? 266
1. Inform the woman ahead of time 266
2. Shorten the duration of exposure 267
3. Treat the woman as much as possible like a person who does not have an epidural 267
4. Attend to the woman's emotional needs 272
Restoring women to a central role 273
Conclusion 274
References 274
Chapter 10 The Labor Progress Toolkit
Part 1: Positions and Movements 277
Penny Simkin BA, PT, CCE, CD(DONA) and Ruth Ancheta MA, ICCE, CD(DONA)
Maternal positions and how they affect labor 278
Side-lying positions 279
Pure side-lying and semiprone (exaggerated Sims') 279
The "semiprone lunge" 284
Side-lying release 285
Sitting positions 288
Semisitting 288
Sitting upright 289
Sitting leaning forward with support 290
Standing, leaning forward 292
Kneeling positions 293
Kneeling, leaning forward with support 293
Hands and knees 295
Open knee-chest position 296
Closed knee-chest position 298
Asymmetrical upright (standing, kneeling, sitting) positions 299
Squatting positions 300
Squatting 300
Supported squatting ("dangling") positions 302
Half-squatting, lunging, and swaying 304
Lap squatting 306
Supine positions 308
Supine 308
Sheet"pull-to-push"309
Exaggerated lithotomy (McRoberts' position) 310
Maternal movements in first and second stages 312
Pelvic rocking (also called pelvic tilt) and other movements of the pelvis 312
Hip sifting 314
Flexion of hips and knees in hands and knees position 315
The lunge 316
Walking or stair climbing 317
Slow dancing 318
Abdominal lifting 320
Abdominal jiggling with a rebozo 321
The pelvic press 323
Other rhythmic movements 324
References 326
Chapter 11 The Labor Progress Toolkit
Part 2: Comfort Measures 327
Penny Simkin, BA, PT, CCE, CD(DONA) and Ruth Ancheta, MA, ICCE, CD(DONA)
Introduction: the state of the science regarding non-pharmacologic, complementary, and alternative methods to relieve labor pain 328
General guidelines for comfort during a slow labor 328
Non-pharmacologic methods to relieve labor pain 328
Non-pharmacologic physical comfort measures 330
Heat 330
Cold 331
Hydrotherapy 333
Touch and massage 337
How to give simple brief massages for shoulders and back, hands, and feet 338
Acupressure 343
Acupuncture 344
Continuous labor support from a doula, nurse, or midwife 345
How the doula helps 345
What about staff nurses and midwives as labor support providers? 346
Psychosocial comfort measures 347
Assessing the woman's emotional state 348
Techniques and devices to reduce back pain 350
Counterpressure 350
The double hip squeeze 351
The knee press 353
Cook's counterpressure technique No. 1: ischial tuberosities (IT) 354
Cook's counterpressure technique No. 2: perilabial pressure 355
Techniques and devices to reduce back pain 357
Cold and heat 357
Cold and rolling cold 358
Warm compresses 359
Hydrotherapy 359
Maternal movement and positions 360
Birth ball 360
Transcutaneous electrical nerve stimulation (TENS) 362
Sterile water injections for back pain 364
Breathing for relaxation and a sense of mastery 364
Simple breathing rhythms to teach on the spot in labor 365
Bearing-down techniques for the second stage 366
Spontaneous bearing down (pushing) 366
Self-directed pushing 367
Directed pushing 367
Conclusion 367
References 368
Index 371