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Simkin's Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia

Simkin's Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia

9781119754466
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Description
SIMKIN’S LABOR PROGRESS HANDBOOK

Get ready to enhance your expertise in the world of childbirth with Simkin’s Labor Progress Handbook — a trusted resource tailored for childbirth medical practitioners

This invaluable guide unravels the complexities of labor, equipping you with practical strategies to overcome challenges encountered along the way. Inside this comprehensive book, you’ll discover a wealth of low-technology, evidence-based interventions designed to prevent and manage difficult or prolonged labors. Grounded in research and practical experience, these approaches are tailored by doulas and clinicians to provide optimal care and achieve successful outcomes.

The fifth edition of this prestigious text includes information on::

  • Labor dystocia causes and early interventions and strategies promoting normal labor and birth
  • Application of fetal heart rate monitoring (intermittent auscultation, continuous electronic fetal monitoring, and wireless telemetry) while promoting movement and labor progress
  • The role of oxytocin and labor progress, and ethical considerations in oxytocin administration
  • Prolonged prelabor and latent first through fourth stage labor, addressing factors associated with dystocia
  • Positions, comfort measures and respectful care

With meticulous referencing and clear, practical instructions throughout, Simkin’s Labor Progress Handbook continues to be a timely and accessible guide for novices and experts alike, including doulas, nurses, midwives, physicians, and students.

Product Details
101491
9781119754466

Data sheet

Publication date
2024
Issue number
5
Cover
paperback
Pages count
384
Dimensions (mm)
185.00 x 230.00
  • List of Contributors xvi

    Foreword xviii

    Chapter 1: Introduction 1
    Lisa Hanson, PhD, CNM, FACNM, FAAN and Emily Malloy, PhD, CNM

    Causes and prevention of labor dystocia: a systematic approach 1

    Notes on this book 4

    Note from the authors on the use of gender-inclusive language 5

    Conclusion 5

    References 5

    Chapter 2: Respectful Care 7
    Amber Price DNP, CNM, MSN, RN 7

    Health system conditions and constraints 8

    LGBTQ birth care 9

    RMC and pregnant people in larger bodies 9

    Shared decision-making 10

    Expectations 11

    The impact of culture on the birth experience 12

    Traumatic births 12

    Trauma survivors and prevention of PTSD 13

    Trauma-informed care as a universal precaution 15

    Obstetric violence 16

    Patient rights 17

    Consent 17

    Maternal mortality 18

    References 19

    Chapter 3: Normal Labor and Labor Dystocia: General Considerations 22
    Lisa Hanson, PhD, CNM, FACNM, FAAN, Venus Standard, MSN, CNM, LCCE, FACNM, andPenny Simkin, BA, PT, CCE, CD(DONA)

    What is normal labor? 22

    What is labor dystocia? 26

    What is normal labor progress and what practices promote it? 26

    Why does labor progress slow or stop? 28

    Prostaglandins and hormonal influences on emotions and labor progress 29

    Disruptions to the hormonal physiology of labor 30

    Hormonal responses and gender 30

    “Fight-or-flight” and “tend-and-befriend” responses to distress and fear during labor 31

    Optimizing the environment for birth 32

    The psycho-emotional state of the pregnant person: wellbeing or distress? 33

    Pain versus suffering 33

    Assessment of pain and coping 34

    Emotional dystocia 34

    Psycho-emotional measures to reduce suffering, fear, and anxiety 34

    Before labor, what the caregiver can do 34

    During labor: tips for caregivers and doulas, especially if meeting the laboring client for the first time in labor 37

    Conclusion 38

    References 38

    Chapter 4: Assessing Progress in Labor 41
    Wendy Gordon, DM, MPH, CPM, LM, with contributions by Gail Tully, BS, CPM, andLisa Hanson, PhD, CNM, FACNM, FAAN

    Before labor begins 42

    Fetal presentation and position 42

    Abdominal contour 42

    Location of the point of maximum intensity (PMI) of the fetal heart tones via auscultation 42

    Leopold’s maneuvers for identifying fetal presentation and position 46

    Abdominal palpation using Leopold’s maneuvers 46

    Estimating engagement: The rule of fifths 49

    Malposition 53

    Other assessments prior to labor 53

    Estimating fetal weight 53

    Assessing the cervix prior to labor 54

    Assessing prelabor 55

    Six ways to progress 55

    Assessments during labor 55

    Visual and verbal assessments 55

    Hydration and nourishment 55

    Psychology 56

    Quality of contractions 56

    Vital signs 57

    Purple line 58

    Assessing the fetus 58

    Fetal movements 58

    Gestational age 58

    Meconium 59

    Fetal heart rate (FHR) 59

    Internal assessments 67

    Vaginal examinations: indications and timing 68

    Performing a vaginal examination during labor 68

    Assessing the cervix 69

    Assessing the presenting part 70

    Identifying those fetuses likely to persist in an OP position throughout labor 75

    The vagina and bony pelvis 76

    Putting it all together 76

    Assessing progress in the first stage 76

    Features of normal latent phase 76

    Features of normal active phase 76

    Assessing progress in the second stage 77

    Features of normal second stage 77

    Conclusion 77

    References 77

    Chapter 5: Role of Physiologic and Pharmacologic Oxytocin in Labor Progress 82
    Elise Erickson, PhD, CNM, FACNM and Nicole Carlson, PhD, CNM, FACNM, FAAN

    History of oxytocin discovery and use in human labor 83

    Structure and function of oxytocin 83

    Oxytocin receptors 83

    Oxytocin and spontaneous labor onset and progression 84

    Promoting endogenous oxytocin function in spontaneous labor 85

    Ethical considerations in oxytocin administration 85

    Oxytocin use 86

    Oxytocin use during latent phase labor 87

    Oxytocin use during active phase labor 87

    Oxytocin use during second stage labor 88

    Changes in contemporary populations and labor progress 88

    Oxytocin dosing 89

    High dose/low dose 89

    Variation in oxytocin dosing among special populations 89

    Higher body mass index 89

    Nullipara 90

    Maternal age 90

    Epidural 91

    Problems associated with higher doses or longer oxytocin infusion 91

    Postpartum hemorrhage 91

    Fetal Intolerance to labor 92

    Oxytocin holiday 92

    Breastfeeding and beyond 92

    New areas of oxytocin research 93

    Conclusion 93

    References 93

    Chapter 6: Prolonged Prelabor and Latent First Stage 101
    Ellen L. Tilden, PhD, RN, CNM, FACNM, Jesse Remer, BS, CD(DONA),BDT(DONA), LCCE, FACCE, and Joyce K. Edmonds, PhD, MPH, RN

    The onset of labor: key elements of recognition and response 102

    Defining labor onset 102

    Signs of impending labor 103

    Prelabor 103

    Prelabor vs labor: the dilemma 103

    Delaying latent labor hospital admissions 103

    Anticipatory guidance 104

    Anticipatory guidance for coping prior in prelabor 105

    Sommer’s New Year’s Eve technique 106

    Prolonged prelabor and the latent phase of labor 106

    Fetal factors that may prolong early labor 107

    Optimal fetal positioning: prenatal features 107

    Miles circuit 109

    Support measures for pregnant people who are at home in prelabor and the latent phase 110

    Some reasons for excessive pain and duration of prelabor or the latent phase 111

    Iatrogenic factors 112

    Cervical factors 112

    Management of cervical stenosis or the “zipper” cervix 112

    Other soft tissue (ligaments, muscles, fascia) factors 112

    Emotional dystocia 113

    Troubleshooting Measures for Painful Prolonged Prelabor or Latent Phase 113

    Measures to Alleviate Painful, Non-progressing, Non-dilating Contractions in Prelabor or Latent Phase 114

    Synclitism and asynclitism 114

    Open knee–chest position 118

    Closed knee–chest position 119

    Side-lying release 119

    When progress in prelabor or latent phase remains inadequate 120

    Therapeutic rest 120

    Nipple stimulation 120

    Membrane sweeping 121

    Artificial rupture of membranes in latent labor 121

    Can prenatal actions prevent some postdates pregnancies, prolonged prelabors, or early labors? 121

    Prenatal preparation of the cervix for dilation 121

    References 125

    Chapter 7: Prolonged Active Phase 130
    Amy Marowitz, DNP, CNM

    What is active labor? Description, definition, diagnosis 131

    When is active labor prolonged or arrested? 131

    Possible causes of prolonged active labor 132

    Treatment of prolonged labor 132

    Fetopelvic factors 132

    How fetal malpositions and malpresentation delay labor progress 134

    Determining fetopelvic relationships 134

    Malpositions 134

    Malpresentations 134

    Use of ultrasound 135

    Artificial rupture of the membranes (amniotomy) when there is a fetal malposition or malpresentation 135

    Epidural analgesia and malposition or malpresentation 135

    Maternal positions and movements for suspected malposition, malpresentation, or any “poor fit” 136

    Overview and evidence 136

    Positions to encourage optimal fetal positioning 137

    Forward-leaning positions 137

    Side-lying positions 137

    Asymmetrical positions and movements 137

    Abdominal lifting 142

    “Walcher’s” position 142

    Flying cowgirl 142

    Low technology clinical approaches to alter fetal position 144

    Digital or manual rotation of the fetal head 144

    Digital rotation 145

    Manual rotation 146

    Early urge to push, cervical edema, and persistent cervical lip 147

    Manual reduction of a persistent cervical lip 148

    Reducing swelling of the cervix or anterior lip 148

    Disruptions to the hormonal physiology of labor 150

    Overview 150

    If emotional dystocia is suspected 150

    Predisposing factors theorized to contribute to emotional dystocia 151

    Possible indicators of emotional dystocia during active labor 151

    Measures to help cope with expressed fears 151

    Hypocontractile uterine activity 152

    Factors that can contribute to contractions of inadequate intensity and/or frequency 152

    Immobility 152

    Environmental and emotional factors 152

    Uterine lactate production in long labors 152

    Sodium bicarbonate 153

    Calcium carbonate 154

    When the cause of inadequate contractions is unknown 154

    Breast stimulation 154

    Walking and changes in position 154

    Acupressure or acupuncture 154

    Coping and comfort issues 155

    Individual coping styles 155

    Simkin’s 3 Rs: Relaxation, rhythm, and ritual: The essence of coping during the first stage of labor 156

    Hydrotherapy: Warm water immersion or warm shower 156

    Comfort measures for back pain 156

    Exhaustion 157

    Sterile water injections 158

    Procedure for subcutaneous sterile water injections 159

    Hydration and nutrition 160

    Conclusion 160

    References 160

    Chapter 8: Prevention and Treatment of Prolonged Second Stage of Labor 166
    Kathryn Osborne, PhD, CNM, FACNM and Lisa Hanson, PhD, CNM, FACNM, FAAN

    Definitions of the second stage of labor 167

    Phases of the second stage of labor 167

    The latent phase of the second stage 168

    Evidence-based support during the latent phase of second stage labor 169

    What if the latent phase of the second stage persists? 169

    The active phase of the second stage 169

    Physiologic effects of prolonged breath-holding and straining 170

    Effects on the birth giver 170

    Effects on the fetus 170

    Spontaneous expulsive efforts 171

    Diffuse pushing 172

    Second stage time limits 173

    Possible causes and physiologic solutions for second stage dystocia 174

    Position changes and other strategies for suspected occiput posterior or persistent occiput transverse fetuses 174

    The use of supine positions 174

    Why not the supine position? 176

    Use of the exaggerated lithotomy position 177

    Differentiating between pushing positions and birth positions 178

    Knees together pushing 178

    Leaning forward while kneeling, standing, or sitting 178

    Squatting positions 178

    Asymmetrical positions 180

    Lateral positions 181

    Supported squat or “dangle” positions 181

    Other strategies for malposition and back pain 182

    Early interventions for suspected persistent asynclitism 183

    Positions and movements for persistent asynclitism in second stage 188

    Nuchal hand or hands at vertex delivery 190

    If cephalopelvic disproportion or macrosomia (“poor fit”) is suspected 190

    The influence of time on cephalopelvic disproportion 191

    Fetal head descent 191

    Verbal support of spontaneous bearing-down efforts 192

    Guiding the birthing person through crowning of the fetal head 192

    Hand skills to protect the perineum 192

    Perineal management during second stage 194

    Topical anesthetic applied to the perineum 194

    Differentiating perineal massage from other interventions 194

    Waterbirth 194

    Positions for suspected “cephalopelvic disproportion” (CPD) in second stage 197

    Shoulder dystocia 197

    Precautionary measures 202

    Two step delivery of the fetal head 204

    Warning signs 204

    Shoulder dystocia maneuvers 205

    The McRoberts’ maneuver 206

    Suprapubic pressure 206

    Hands and knees position, or the Gaskin maneuver 207

    Shrug maneuver 207

    Posterior axilla sling traction (PAST) 208

    Tully’s FlipFLOP pneumonic 208

    Somersault maneuver 208

    Decreased contraction frequency and intensity 210

    If emotional dystocia is suspected 211

    The essence of coping during the second stage of labor 211

    Signs of emotional distress in second stage 211

    Triggers of emotional distress unique to the second stage 211

    Conclusion 213

    References 213

    Chapter 9: Optimal Newborn Transition and Third and Fourth Stage Labor Management 219
    Emily Malloy, PhD, CNM, Lisa Hanson, PhD, CNM, FACNM, and Karen Robinson, PhD,

    Cnm, Facnm

    Overview of the normal third and fourth stages of labor for unmedicated mother and baby 219

    Third stage management: care of the baby 220

    Oral and nasopharynx suctioning 220

    Delayed clamping and cutting of the umbilical cord 221

    Management of delivery of an infant with a tight nuchal cord 222

    Third stage management: the placenta 222

    Physiologic (expectant) management of the third stage of labor 223

    Active management of the third stage of labor 224

    The fourth stage of labor 226

    Baby-friendly (breastfeeding) practices 227

    Supporting microbial health of the infant 228

    Routine newborn assessments 229

    Conclusion 230

    References 230

    Chapter 10: Epidural and Other Forms of Neuraxial Analgesia for Labor: Review of Effects, with Emphasis on Preventing Dystocia 235
    Sharon Muza, BS, CD/BDT(DONA), LCCE, FACCE, CLE and Robin Elise Weiss,Ph.D., MPH, CLC, LCCE, FACCE, AdvCD/BDT(DONA)

    Introduction: analgesia and anesthesia—an integral part of maternity care in many countries 235

    Neuraxial (epidural and spinal) analgesia—new terms for old approaches to labor pain? 236

    Physiological adjustments that support maternal-fetal wellbeing 237

    Multisystem effects of epidural analgesia on labor progress 237

    The endocrine system 237

    The musculoskeletal system 238

    The genitourinary system 239

    Can changes in labor management reduce problems of epidural analgesia? 239

    Descent vaginal birth 243

    Guided physiologic pushing with an epidural 244

    Centering the pregnant person during labor 245

    Conclusion 246

    References 246

    Chapter 11: Guide to Positions and Movements 249
    Lisa Hanson, PhD, CNM, FACNM, FAAN and Emily Malloy, PhD, CNM

    Maternal positions and how they affect labor 250

    Side-lying positions 250

    Pure side-lying and semiprone (exaggerated Sims’) 250

    The “semiprone lunge” 256

    Side-lying release 257

    Sitting positions 259

    Semisitting 259

    Sitting upright 261

    Sitting, leaning forward with support 262

    Standing, leaning forward 263

    Kneeling positions 264

    Kneeling, leaning forward with support 264

    Hands and knees 266

    Open knee–chest position 266

    Closed knee–chest position 269

    Asymmetrical upright (standing, kneeling, sitting) positions 269

    Squatting positions 270

    Squatting 270

    Supported squatting (“dangling”) positions 272

    Half-squatting, lunging, and swaying 274

    Lap squatting 274

    Supine positions 277

    Supine 277

    Sheet “pull-to-push” 278

    Exaggerated lithotomy (McRoberts’ position) 279

    Maternal movements in first and second stages 280

    Pelvic rocking (also called pelvic tilt) and other movements of the pelvis 281

    Hip sifting 282

    Flexion of hips and knees in hands and knees position 283

    The lunge 284

    Walking or stair climbing 285

    Slow dancing 286

    Abdominal lifting 288

    Abdominal jiggling with a shawl 289

    The pelvic press 290

    Other rhythmic movements 292

    References 293

    Chapter 12: Guide to Comfort Measures 294
    Emily Malloy, PhD, CNM and Lisa Hanson, PhD, CNM, FACNM, FAAN

    Introduction: the state of the science regarding non-pharmacologic, complementary, and alternative

    methods to relieve labor pain 295

    General guidelines for comfort during a slow labor 295

    Non-pharmacologic physical comfort measures 296

    Heat 296

    Cold 297

    Hydrotherapy 299

    How to monitor the fetus in or around water 301

    Touch and massage 302

    How to give simple brief massages for shoulders and back, hands, and feet 302

    Acupuncture 307

    Acupressure 307

    Continuous labor support from a doula, nurse, or midwife 307

    How the doula helps 308

    What about staff nurses and midwives as labor support providers? 309

    Assessing the laboring person’s emotional state 310

    Techniques and devices to reduce back pain 312

    Counterpressure 312

    The double hip squeeze 312

    The knee press 314

    Cook’s counterpressure technique No. 1: ischial tuberosities (IT) 315

    Cook’s counterpressure technique No. 2: perilabial pressure 316

    Techniques and devices to reduce back pain 318

    Cold and heat 318

    Cold and rolling cold 318

    Warm compresses 319

    Maternal movement and positions 319

    Birth ball 320

    Transcutaneous electrical nerve stimulation (TENS) 321

    Sterile water injections for back labor 323

    Procedure for subcutaneous sterile water injections 324

    Breathing for relaxation and a sense of mastery 324

    Simple breathing rhythms to teach on the spot in labor 325

    Bearing-down techniques for the second stage 325

    Spontaneous bearing down (pushing) 325

    Self-directed pushing 326

    Conclusion 326

    References 326

    Index 329

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