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labor & delivery

Giving birth after gestation. Management: avoid elective cessarean section [3] - cervical dilation of 6 cm should be considered the start of active labor (previously 4 cm) - multiparous women should be allowed to push for 2 hours, nulliparous women for 3 hours before arrest of labor is diagnosed - longer durations are acceptable, epecially with epidural abesthesia - vaginal delivery with vacuum or forceps in the second stage is an alternative to cesarean delivery [3] - low-intervention techniques for low risk women [4] - frequent position changes during labor - water immersion during the first stage of labor - continuous one-on-one emotional support - use hand-held Doppler devices for intermittent auscultation [4] - lying-down position is more conducive to spontaneous vaginal delivery than the upright position in women with low spinal epidural anesthesia [5]

Related

birth (childbirth, parturition) cesarean section (C-section) complications of labor & delivery perinatal

Specific

home childbirth maternal immersion in water; water baby preterm delivery vaginal delivery

General

labor

References

  1. Dorland's Medical Dictionary, 23rd ed., WB Saunders, Philadelphia, 1990
  2. Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol. 2006 Jan;194(1):10-3. PMID: 16389004
  3. American College of Obstetricians and Gynecologists (ACOG) Safe Prevention of the Primary Cesarean Delivery Obstetric Care Consensus. Number 1, March 2014 http://www.acog.org/Resources_And_Publications/Obstetric_Care_Consensus_Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery
  4. American College of Obstetricians and Gynecologists (ACOG) Approaches to Limit Intervention During Labor and Birth Committee Opinion. Feb 2017 http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth
  5. The Epidural and Position Trial Collaborative Group. Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. BMJ 2017 Oct 18; 359:j4471 PMID: 29046273 Free PMC Article
  6. Cahill AG, Srinivas SK, Tita ATN et al. Effect of immediate vs delayed pushing on rates of spontaneous vaginal delivery among nulliparous women receiving neuraxial analgesia: A randomized clinical trial. JAMA 2018 Oct 9; 320:1444. PMID: 30304425 Sperling JD, Gossett DR. Immediate vs delayed pushing during the second stage of labor. JAMA 2018 Oct 9; 320:1439 PMID: 30304414