II. Management: General Measures
- Avoid early hospitalization in Latent Phase of Labor
- See Latent Phase of Labor for management
- Consider Structured Intermittent Auscultation (SIA)
- Preferred over Continuous Electronic Fetal Monitoring
- Consider using CEFM only in high risk pregnancies
-
Informed Consent regarding Labor Anesthesia
- Epidural Anesthesia increases risk of ceserean
- Avoid epidural and intrathecal Anesthesia until >4 cm
- Consider Peanut Ball placed between knees, in lateral decubitus position, following Epidural Anesthesia
- Encourage mobility (walking, sitting, standing, kneeling)
- Avoid induction if Cervix unripe if possible
- See Bishops Score
- Consider Cervical Ripening
- Antepartum labor classes (e.g. Lamaze)
- Patient Education on what to expect in labor
- Physician and nurse team impacts Labor Dystocia
- Be patient in slow progressing nullip
- Increased total contact time decreases ceserean rate
-
Continuous Labor Support
- Encourage Doula use
- Continuous Labor Support shortens labor by 35 minutes and reduces C-Section and operative Vaginal Delivery risk
- Amniotomy when in Active Phase of Labor
- Employ alternatives to labor Analgesics
- Consider high dose Oxytocin Augmentation in nullips
- Decrease labor duration by 2 hours without added risk
- Merrill (1999) Obstet Gynecol 94:455-63 [PubMed]
III. References
- Shields (2000) ALSO, F:1-14
- Warenski (1997) Clin Obstet Gynecol 40(3):525-32 [PubMed]