MANAGEMENT OF PROLONGED LATENT PHASE LABOR

Prolonged latent phase labor can be a physical, emotional, and mental challenge for both the woman in labor, her support system, and nurse-midwife. In this article, four nurse-midwives offer suggestions for coping with this common clinical dilemma.     

THE EFFECT OF MATERNAL BEARING-DOWN EFFORTS ON ARTERIAL UMBILICAL CORD pH AND LENGTH OF THE SECOND STAGE OF LABOR

This study was conducted to compare two types of maternal bearing-down techniques as they relate to the fetal and maternal outcomes of arterial umbilical cord blood pH and length of the second stage of labor. A convenience sample was drawn from the laboring women at a 305. bed medical center who met specific inclusion criteria. Women self-selected to one of two bearing-down groups: spontaneous or Valsalva. Subjects were given specific instructions for the chosen method. The Valsalva group was comprised of 14 subjects, and the spontaneous group was comprised of 16 subjects. The groups were found to be comparable after analysis of several variables. Results of statistical analysis using t- test indicated that, in this small sample, there is no relationship between the second stage bearing-down method and arterial umbilical cord blood pH or length of the second stage of labor. These findings support the conclusions of several studies: using the spontaneous bearing-down method does not have a deletenous effect upon the mother or the fetus. Several recommendations are made for future research based on methodological issues raised during this study     

THE EFFECTS OF EARLY ELECTIVE AMNIOTOMY ON THE LENGTH OF LABOR AND THE CONDITION OF THE FETUS

Amniotomy is done frequently for the purpose of shortening labor or applying an internal fetal monitor electrode. To determine if amniotomy is warranted as a routine procedure, a systematic review of literature on the subject was done. Studies pertaining to the length of labor showed either no consistent effect of amniotomy, or a shorter labor by a maximum of 61.5 min with early amniotomy. Studies pertaining to the condition of the fetus showed increased incidence of caput succedaneum, skull bone disalignment, and early decelerations with early amniotomy. A small controlled study showed decreased pH of newborns with early amniotomy. There was no significant difference in Apgar score or neurological examination of the newborn with early amniotomy. The author concluded that early amniotomy should be reserved for use with specific indications, and should not be used routinely in the low-risk parturient.