Proactive support of labor: the challenge of normal childbirth

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Acknowledgments......Page 13
Web-Forum......Page 15
1.2 Target readership......Page 17
Section 2: Back to basics......Page 18
1.4 Evidence grading......Page 19
1.6 Classification of birth professionals......Page 20
REFERENCES......Page 21
Section 1: A wake-up call......Page 23
2.1.1 Operative solutions for failed labors......Page 25
2.2 Instrumental delivery rates......Page 26
2.4.1 Psychological harm......Page 27
2.4.3 Medical harm to subsequent pregnancies......Page 28
2.4.5 Neonatal and long-term pediatric morbidity......Page 29
2.4.8 Social damage......Page 30
REFERENCES......Page 31
3.1.1 Symptom-based interventions......Page 35
3.2.1 Non-management of first-stage labor......Page 36
3.2.2 Lack of professional interest......Page 37
3.2.4 The expectant approach......Page 38
3.3 Mechanics-oriented view of childbirth......Page 39
3.3.1 The mechanistic paradox......Page 40
REFERENCES......Page 41
4.1 Idle faith in technology......Page 43
4.2 Negative psychology......Page 44
4.2.2 The culture of fear......Page 45
4.3.2 Frustratingly casual attitudes......Page 46
4.4 Care of fetus versus care of mother......Page 47
4.5 Summary......Page 48
REFERENCES......Page 49
5.1.1 Adverse working relations......Page 51
5.2.2 Disputes in midwife-centered systems......Page 52
5.3.1 Autonomous gate-keepers......Page 53
5.3.3 Discontinuous and unsafe care......Page 54
5.4.1 In search of the evidence......Page 55
REFERENCES......Page 56
6.1 The applause phenomenon......Page 58
6.2.1 Biased patient information......Page 59
6.3.3 False information......Page 61
6.4 Ignoring the evidence......Page 62
6.5.1 Deficient training in labor and delivery skills......Page 63
6.5.2 Post-doctoral education and development......Page 64
6.7 Summary......Page 65
REFERENCES......Page 66
Section 2: Back to basics......Page 69
7.1.1 Duration of natural birth......Page 71
7.3 Psychovegetative regulation......Page 72
7.3.2 Biological effects of stress......Page 73
REFERENCES......Page 74
8.1.1 The fetal trigger......Page 75
8.2.1 Cervical ripening......Page 76
8.3.2 The activation of the myometrium......Page 77
8.5.1 Uterine coordination......Page 78
8.5.3 Cervical resistance......Page 79
8.7 First labor compared with subsequent labors......Page 80
8.8.1 The placental reserve capacity......Page 81
8.9.1 Induction of labor......Page 82
8.10 Summary......Page 83
REFERENCES......Page 84
9.1.2 Fundamental reassessment......Page 86
9.1.4 Defining the beginning of labor......Page 87
9.1.6 No deceleration phase......Page 88
9.2.2 Retraction phase and wedging (descent) phase of first-stage labor......Page 89
9.2.3 Relationship between dilatation and descent......Page 90
9.3.2 Natural demarcation point......Page 91
9.3.4 The evidence......Page 92
9.5 Summary......Page 93
REFERENCES......Page 94
10.1.1 Pelvic adequacy......Page 95
10.1.2 Internal rotation and extension......Page 96
10.3 Expulsive force versus pelvic soft-tissue resistance......Page 97
10.4 Summary......Page 98
REFERENCES......Page 99
11.1.1 Labor pains = contractions of labor......Page 100
11.1.3 Cervical accessibility versus dilatation......Page 101
11.1.5 The transition at full effacement......Page 102
11.1.7 Crucial clarity......Page 103
11.1.9 Pitfall of intrauterine pressure readings......Page 104
11.2.2 Normal progress in dilatation......Page 105
11.2.3 Onset of second-stage labor......Page 106
11.4 Summary......Page 107
REFERENCES......Page 108
Section 3: Proactive support of labor......Page 109
12.1.1 Conceptual birth care......Page 111
12.1.3 Distortion, perversion, confusion......Page 112
12.2.1 Justification and rehabilitation......Page 113
12.4.2 An overall plan......Page 114
12.4.7 Early detection and correction of dysfunctional labor......Page 115
12.4.11 Prelabor preparation and assurance......Page 116
12.4.15 Appropriate working relations......Page 117
REFERENCES......Page 118
13.1 Unique first experience......Page 120
13.2.3 Fetal distress......Page 121
13.2.6 Specification of the meaning of multiparity......Page 122
13.3.2 Protracted labor in multiparas: a mechanical problem......Page 123
13.3.3 Correct mindset......Page 124
REFERENCES......Page 125
14.1 Professional responsibility......Page 126
14.2.1 Pains......Page 127
14.2.4 Immediate progress......Page 128
14.3.2 Documentation......Page 129
14.4.1 The concept of the latent phase discarded......Page 130
14.5.1 False-negative diagnosis......Page 131
14.6.1 Factors contributing to a false start......Page 132
14.6.2 Management of a false start......Page 133
14.6.4 Preventing a false start......Page 134
14.8 Summary......Page 135
REFERENCES......Page 136
15 Prevention of long labor......Page 137
15.1.2 Impact of prolonged labor......Page 138
15.2 The partogram......Page 139
15.2.1 A prospective and simple, visual record......Page 140
15.3.1 Early assessments......Page 141
15.4.1 Prediction of the hour of birth......Page 142
15.5.1 Selective but timely use of amniotomy and oxytocin......Page 143
15.5.3 Misguidance from poor studies......Page 144
15.6 Summary......Page 145
REFERENCES......Page 146
16.1.2 Post-modern trends......Page 147
16.2 Personal attention and personal continuity......Page 148
16.3.1 The evidence for continuous support......Page 149
16.3.3 One-on-one companion in labor......Page 150
16.3.4 Doula services......Page 151
16.4 Summary......Page 152
REFERENCES......Page 153
17.1.1 Selective versus routine amniotomy......Page 154
17.1.3 Safety of amniotomy......Page 155
17.2.1 Misunderstandings......Page 156
17.3 Evidence-based augmentation......Page 157
17.3.1 Safety......Page 158
17.3.3 Safe and effective dosage scheme......Page 159
17.3.6 Poor response......Page 160
17.5 Hyperstimulation......Page 161
17.5.2 No additional fetal risks......Page 162
17.6.2 Multiparas......Page 163
17.8 Summary......Page 164
REFERENCES......Page 165
18.1.1 Insecurity, anxiety, and pain......Page 166
18.1.3 The spectrum of behavioral responses......Page 167
18.1.5 Psychosocial and environmental influences......Page 168
18.2.1 Evidence-based recommendations......Page 169
18.3 Pain and women\'s labor experience......Page 170
18.4 Summary......Page 171
REFERENCES......Page 172
19.1 Antenatal classes......Page 173
19.3 Personal education......Page 174
19.4.1 Prelabor information......Page 175
19.4.3 Parous rehabilitation......Page 176
19.7 Summary......Page 177
REFERENCES......Page 178
20.1.1 Poor effectiveness......Page 179
20.1.4 Neonatal hazards of opiates......Page 180
20.1.7 PCA with remifentanil......Page 181
20.2.2 Effectiveness of epidural block......Page 182
20.2.4 Direct adverse effects......Page 183
20.2.5 Indirect adverse effects......Page 184
20.2.7 Prejudicing nursing labor support......Page 185
20.2.8 General considerations......Page 186
20.2.11 Case selection for epidural......Page 187
REFERENCES......Page 188
21.1 The spectrum of dynamic labor disorders......Page 191
21.2 Primary ineffective labor......Page 192
21.2.2 Early recognition and correction......Page 193
21.2.4 Proactive support of labor......Page 194
21.3.1 Classic misapprehensions......Page 195
21.3.2 Clinical approach to secondary arrest of dilatation......Page 196
21.4 Secondary arrest at full dilatation......Page 197
21.4.2 Expert management......Page 198
21.5.2 Pushing too early......Page 199
21.5.3 Ineffective pushing techniques......Page 200
21.7 The refractory or unresponsive uterus......Page 201
21.8 Augmentation versus induction......Page 202
21.9.1 Hypertonic or uncoordinated dystocia......Page 203
21.11 Summary......Page 204
REFERENCES......Page 205
22.2 Diagnosis......Page 206
22.3.2 Poorly defined concept of CPD......Page 207
22.3.4 Self-fulfilling prophecies......Page 208
22.4 Expert policy and diagnosis in first labors......Page 209
22.6.1 \"Functionally full dilatation\" - a misnomer......Page 210
22.6.3 Occiput posterior in first-stage labor......Page 211
22.7.1 Importance of correct definitions......Page 212
22.7.3 Occiput posterior in second-stage labor......Page 213
22.9.1 Unpredictability......Page 214
22.10 Final classification for meaningful audit......Page 215
REFERENCES......Page 216
23.1 Iatrogenic harm......Page 218
23.2 Limitation of cervix scores......Page 219
23.3 Hazards of cervical priming......Page 220
23.4.2 Educative drawbacks......Page 221
23.6.1 Firmness clauses......Page 222
23.7 Summary......Page 223
REFERENCES......Page 224
24.1.1 Placental circulatory competence......Page 226
24.1.4 Umbilical cord compression......Page 227
24.1.6 Fetal distress......Page 228
24.1.7 Meconium......Page 229
24.2 Practice 1: Intrapartum screening/monitoring......Page 230
24.2.3 Fetal monitoring by intermittent auscultation......Page 231
24.2.4 Continuous electronic monitoring......Page 232
24.2.5 Detection of meconium and clinical consequences......Page 233
24.3.2 Fetal scalp blood sampling......Page 234
24.3.3 New techniques......Page 235
24.4 Practice 3: Interventions......Page 236
24.4.2 Intrauterine resuscitation......Page 237
REFERENCES......Page 238
25.1 The specter of cerebral palsy......Page 241
25.1.2 Hypoxic-ischemic encephalopathy......Page 242
25.2 Legal liability concerns......Page 243
25.2.2 Preventing errors......Page 244
REFERENCES......Page 245
26.1.1 Staff consensus......Page 246
26.1.3 Scale......Page 247
26.2.1 Nursing services......Page 248
26.2.4 Responsibilities and liability......Page 249
26.3.2 Current crisis in obstetrics services......Page 250
26.3.3 Societal changes......Page 251
26.3.5 Primary care......Page 252
26.3.7 Integration......Page 253
26.3.8 Case selection for home birth......Page 254
26.5 Summary......Page 255
REFERENCES......Page 256
27.1.1 Content......Page 257
27.1.3 Commitment to low intervention rates......Page 258
REFERENCES......Page 259
28.1.1 Objective outcome measures......Page 261
28.1.3 Duration of labor......Page 262
REFERENCES......Page 263
29.1 Problems and pitfalls in inter-hospital comparisons......Page 264
29.2.4 Practice versus ideal......Page 265
29.2.6 Obstetric quality ranking and league tables......Page 267
REFERENCES......Page 268
30.1 The interventional component......Page 269
30.2.1 Inconclusive controlled trials......Page 270
30.2.2 Convincing clinical evidence......Page 271
REFERENCES......Page 272
Index......Page 275