Foreword to the third edition

xv

Foreword to the second edition

xvii

Foreword to the first edition

xxi

Acknowledgments

xxiii

Chapter 1

Introduction   Penny Simkin, BA, PT, CCE, CD (DONA), and Ruth Ancheta, BA5 ICCE, CD (DONA)

3

Some important differences in maternity care between the United States, the United Kingdom, and Canada

8

Notes on this book

12

Changes in this third edition

12

Material on epidurals

13

Conclusion

13

References

14

Chapter 2

Dysfunctional Labor: General Considerations   Penny Simkin, BA, PT, CCE, CD(DONA), and Ruth Ancheta, BA5 ICCE, CD(DONA)

15

What is normal labor?

16

What is dysfunctional labor?

21

Why does labor progress slow down or stop?

23

A role for the fetus in regulating labor?

23

The psychoemotional state of the woman: maternal well-being or maternal distress?

24

Pain versus suffering

24

The “fight-or-flight” and “tend-and-beiriend” responses to distress and fear in labor

29

The environment for birth

31

Psychoemotional measures

31

Physical comfort measures

33

Physiologic measures

34

Why focus on maternal position?

35

Monitoring the mobile woman’s fetus

37

Auscultation

37

When EFM is required: options to enhance maternal mobility

37

Continuous EFM

38

Intermittent EFM

41

Telemetry

42

Techniques to elicit stronger contractions

45

Conclusion

46

References

46

Chapter 3

Assessing Progress in Labor   Suzy Myers, LM, CPM, MPH, with contributions by Gail Tully, BS, CPMj CD(DONA), and Lisa Hanson, PhD, CNM, FACNM

51

Before labor begins

52

Malposition

52

Leopold’s maneuvers

57

Belly mapping

60

Other assessments prior to labor

64

Assessments during labor

66

Position, attitude, and station of the fetus

66

Vaginal examinations: indications and timing

66

Performing a vaginal examination during labor

67

Assessing the cervix

70

Unusual cervical findings

71

The presenting part

72

The vagina and bony pelvis

80

Quality of contractions

81

Assessing the mother’s condition

84

Hydration and nourishment

84

Vital signs

85

Psychology

85

Assessing the fetus

86

Fetal heart rate

86

How to perform intermittent auscultation

87

When using continuous electronic fetal monitoring

89

The three-tiered fetal heart rate interpretation system

91

Putting it all together

94

Assessing progress in the first stage

94

Assessing progress in the second stage

96

Conclusion

96

References

96

Chapter 4

Prolonged Prelabor and Latent First Stage   Penny Simkin, BA, PT, CCE, CD(DONA), and Ruth Ancheta, BA, ICCE, CD(DONA)

101

Is it dystocia?

101

When is a woman in labor?

102

Can prenatal measures prevent the fetal occiput position during labor?

103

The woman who has hours of contractions without dilation

106

The six ways to progress in labor

108

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

111

Iatrogenic factors

111

Cervical factors

111

Fetal factors

112

Emotional factors

112

Troubleshooting measures for painful prolonged prelabor or latent phase

113

Measures to alleviate painful nonprogressing: nondilating contractions in prelabor or the latent phase

115

Synclitism and asynclitism

116

Conclusion

121

References

121

Chapter 5

Prolonged Active Phase of Labor   Penny Simkin, BA, PT, CCE, CD (DONA), and Ruth Ancheta, BA, ICCE, CD (DONA)

124

When is active labor prolonged?

125

Characteristics of prolonged active labor

126

Possible causes of prolonged active labor

127

Fetal and fetopelvic factors

129

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 fetal malposition, cephalopelvic disproportion, or macrosomia

136

Forward-leaning positions

136

Side-lying positions

138

Asymmetric positions and movements

141

Abdominal lifting

144

An uncontrollable premature urge to push

144

If contractions are inadequate

146

Immobility

147

Medication

149

Dehydration

150

Exhaustion

151

Uterine lactic acidosis as a cause of inadequate contractions

151

When the cause of inadequate contractions is unknown

153

If there is a persistent anterior cervical lip or a swollen cervix

156

Positions to reduce an anterior cervical lip or a swollen cervix

156

Other methods

158

Manual reduction of a persistent cervical lip

158

If emotional dystocia is suspected

158

Assessing the woman’s coping

158

Indicators of emotional dystocia during active labor

160

Predisposing factors for emotional dystocia

161

Helping the woman state her fears

161

How to help a laboring woman in distress

162

Special needs of childhood abuse survivors

164

Incompatibility or poor relationship with staff

166

If the source of the woman’s anxiety cannot be identified

166

Conclusion

167

References

167

Chapter 6

Prolonged Second Stage of Labor   Penny Simkin, BA, FT, CCE, CD (DONA), and Ruth Ancheta, BA, ICCE, CD (DONA)

173

Definitions of the second stage of labor

174

Phases of the second stage of labor

174

The latent phase of the second stage

174

The active phase of the second stage

177

Physiologic effects of prolonged breath-holding and straining

178

If the woman has an epidural

182

How long an active phase of second stage is too long?

186

Possible etiologies and solutions for second-stage dystocia

188

Maternal positions and other strategies for suspected occiput posterior or persistent occiput transverse fetuses

188

Manual interventions to reposition the occiput posterior fetus

200

Early interventions for suspected persistent asynclitism

200

If cephalopelvic disproportion or macrosomia (“poor fit”) is suspected

205

Positions for “possible cephalopelvic disproportion” in second stage

206

Shoulder dystocia

214

If contractions are inadequate

215

If emotional dystocia is suspected

215

The essence of coping during the second stage of labor

215

Conclusion

219

References

219

Chapter 7

Optimal Newborn Transition and Third and Fourth Stage Labor Management   Lisa Hanson, PhD, CNM, FACNM, and Penny Simkin, BA, PT, CCE, CD(DONA)

224

Overview of the normal third and fourth stages of labor for baby and unmedicated mother

225

Third stage management: care of the baby

227

Oral and nasopharynx suctioning

227

Delayed clamping and cutting of the umbilical cord

228

Third stage management: the placenta

229

Expectant physiologic management of the third stage of labor

229

Active management of the third stage of labor

230

The fourth stage of labor

234

Keeping the mother and baby together

234

Baby-friendly (breastfeeding) practices

236

Ten steps to successful breastfeeding

237

Routine newborn assessments

237

Conclusion

238

References

238

Chapter 8

Low-Technology Clinical Interventions to Promote Labor Progress   Lisa Hanson, PhD, CNM, FACNM

242

Intermediate-level interventions for management of problem labors

243

When progress in preiabor or latent phase remains inadequate

244

Therapeutic rest

244

Nipple stimulation

244

Management of cervical stenosis or the “zipper” cervix

245

When progress in active phase remains inadequate

245

Artificial rupture of the membranes (AROM)

246

Digital or manual rotation of the fetal head

246

Manual reduction of a persistent cervical lip

250

Reducing swelling of the cervix or anterior lip

251

Fostering normality in birch

251

Perineal management

251

When progress in second stage labor remains inadequate

257

Duration of second stage labor

257

Supportive directions for bearing down efforts

258

Hand maneuvers and anticipatory management of intrapartum problems

258

Shoulder dystocia

258

Somersault maneuver

265

Nonpharmacologic and minimally invasive techniques for intrapartum pain relief

267

Acupuncture

267

Sterile water injections

269

Nitrous oxide

271

Topical anesthetic applied to the perineum

271

Conclusion

271

References

272

Chapter 9

The Labor Progress Toolkit: Part 1. Maternal Positions and Movements   Penny Simkin, BA, PT5 CCE, CD (DONA), and Ruth Ancheta, BA, ICCE, CD (DONA)

277

Maternal positions

278

Side-lying positions

279

Standing, leaning forward

289

Kneeling positions

290

Squatting positions

297

Supine positions

306

Maternal movements in first and second stages

311

Other rhythmic movements

323

References

324

Chapter 10

The Labor Progress Toolkit: Part 2. Comfort Measures   Penny Simkiri; BA, PT, CCE, CD (DONA), and Ruth Ancheta; BA, TCCE, CD (DONA)

326

General guidelines for comfort during a slow labor

327

Nonpharmacologic physical comfort measures

328

Heat

328

Cold

330

Hydrotherapy

332

Touch and massage

337

Acupressure

345

Acupuncture

347

Continuous labor support from a doula, nurse, or midwife

347

Psychosocial comfort measures

350

Assessing the woman’s emotional state

351

Techniques and devices to reduce back pain

354

Counterpressure

354

The double hip squeeze

355

The knee press

357

Cook’s counterpressure technique No. 1: Ischial tuberosities (I-T)

359

Cook’s counterpressure technique No. 2: perilabial (P-L)

361

Cold and heat

363

Hydrotherapy

365

Movement

366

Birth ball

367

Transcutaneous electrical nerve stimulation (TENS)

368

Sterile water injections for back pain

371

Breathing or moaning for relaxation and a sense of mastery

371

Bearing-down techniques for the second stage

374

Conclusion

376

References

376

Epidural Index

379

Index

381