II. Indications
III. Management: Stage 1
- See Labor Coaching
- Consider Oxytocin Augmentation
- Consider Amniotomy
- Shortens labor duration without reducing chance of successful NSVD
- Indications for cesarean delivery (arrested labor)
- Cervical dilation 6 cm AND
- No cervical change
- At 4 hours if adequate contractions (>200 Montevideo Units) or
- At 6 hours if inadequate contractions
IV. Management: Stage 2
- Consider Oxytocin Augmentation
- Avoid exhausting mother early
- Consider delayed maternal pushing (laboring down)
- Consider not pushing until involuntary urge to push
- Consider waiting until vertex approaches introitus
- Lemos (2017) Cochrane Database Syst Rev (3):CD009124 [PubMed]
- Nulliparous patients with Epidural Anesthesia should be encouraged to start pushing on full cervical dilation
- Consider delayed maternal pushing (laboring down)
- Consider assisted Vaginal Delivery
- Perineal Laceration prevention
- Avoid routine episiotomy (associated with worse perineal Lacerations and greater healing complications)
- Warm perineal compresses may reduce risk of third and Fourth Degree Perineal Lacerations
- Shorter pushes as the head is crowning may reduce perineal Lacerations
- Consider correction of malposition: Occiput Posterior
- See Manual Rotation in Occipitoposterior Presentation
- Maternal repositioning to hands and knees
- Not shown to assist in conversion to Occiput Anterior or to reduce Cesarean Section rates
- Hunter (2007) Cochrane Database Syst Rev (4): CD001063 [PubMed]
- Maternal position change
- Walking and upright position is preferred over supine
- Position mother curling forward from hips
- Consider Intravenous Fluid
- Normal Saline infusion of 250 ml/h (instead of 125 ml/hour) may result in decreased labor duration and fewer C-Sections
V. Management: Dystocia refractory to above management
- See Arrest of the Second Stage of Labor
- Consider Cesarean Section