Laboring Down
From: Daniel R. Hersh, M.D. (dhersh@icsi.net)
Thu Aug 31 15:06:21 2000
Dear listmembers:
How many MD's routinely "labor down" their patients?
Listed below are two abstracts on "laboring down".
Sincerely,
--
Daniel R. Hersh, M.D.
MacGregor Medical Association
Houston, Texas 77058
Former partner of Geffrey Klein, M.D.
TITLE:
A second look at the second stage of labor [see comments]
AUTHORS:
Roberts J; Woolley D
AUTHOR AFFILIATION:
University of Illinois at Chicago, College of Nursing, Department of
Maternal-Child Nursing 60612, USA.
SOURCE:
J Obstet Gynecol Neonatal Nurs 1996 Jun;25(5):415-23
CITATION IDS:
PMID: 8791229 UI: 96383365
COMMENT:
Comment in: J Obstet Gynecol Neonatal Nurs 1997 Jan-Feb;26(1):15
ABSTRACT:
This article focuses on the primary clinical issues during the second
stage of labor: diagnosis, duration, maternal bearing-down efforts, and
fetal descent, and ways to help women with their expulsive efforts
during this time. A pattern of progression for the second
stage/expulsive phase of labor is presented, with an emphasis on the
importance of delaying direction to or encouragement of the woman to
push until the obstetric conditions are optimal for descent and the
women has entered the active phase of the second stage. Ongoing
assessment of fetal status and descent, the quality of uterine
contractions, and maternal condition are emphasized, rather than
arbitrary time limits for the second stage. The use of various care
practices, including maternal position and alternative bearing-down
techniques, which optimize maternal and fetal outcomes, is described.
Finally, women's concerns about this major life experience are
considered in the context of the care that they receive during the
second stage of labor.
TITLE:
The effect of maternal bearing-down efforts on arterial umbilical cord
pH and length of the second stage of
labor.
AUTHORS:
Paine LL; Tinker DD
AUTHOR AFFILIATION:
Department of Obstetrics and Gynecology, Phoenix Indian Medical Center,
AZ 85016.
SOURCE:
J Nurse Midwifery 1992 Jan-Feb;37(1):61-3
CITATION IDS:
PMID: 1538270 UI: 92166893
ABSTRACT:
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 deleterious effect upon
the mother or the fetus. Several recommendations are made for future
research based on methodological issues raised during this study.
