Lisa Hanson PhD, CNM, FACNM, FAAN is Klein Professor and Associate Director of the Marquette University College of Nursing, Midwifery Program, Milwaukee, WI, USA. She practiced as a midwife for 30 years in Milwaukee, WI, USA. Lisa is an active midwifery researcher who has authored numerous scientific articles.

Emily Malloy PhD, CNM is a nurse-midwife in full scope midwifery practice and a midwife researcher who conducts clinical research in Milwaukee, WI, USA. She is a participating faculty at Marquette University College of Nursing, Midwifery program.

Penny Simkin BA, PT, CCE, CD(DONA) is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 15,000 pregnant people, couples, and siblings for childbirth, and assisted hundreds as a doula. She is author of several books for both parents and professionals.

List of Contributors xvi Foreword xviii Chapter 1: Introduction 1Lisa Hanson, PhD, CNM, FACNM, FAAN and Emily Malloy, PhD, CNM Causes and prevention of labor dystocia: a systematic approach 1 Notes on this book 4 Note from the authors on the use of gender-inclusive language 5 Conclusion 5 References 5 Chapter 2: Respectful Care 7Amber Price DNP, CNM, MSN, RN 7 Health system conditions and constraints 8 LGBTQ birth care 9 RMC and pregnant people in larger bodies 9 Shared decision-making 10 Expectations 11 The impact of culture on the birth experience 12 Traumatic births 12 Trauma survivors and prevention of PTSD 13 Trauma-informed care as a universal precaution 15 Obstetric violence 16 Patient rights 17 Consent 17 Maternal mortality 18 References 19 Chapter 3: Normal Labor and Labor Dystocia: General Considerations 22Lisa Hanson, PhD, CNM, FACNM, FAAN, Venus Standard, MSN, CNM, LCCE, FACNM, andPenny Simkin, BA, PT, CCE, CD(DONA) What is normal labor? 22 What is labor dystocia? 26 What is normal labor progress and what practices promote it? 26 Why does labor progress slow or stop? 28 Prostaglandins and hormonal influences on emotions and labor progress 29 Disruptions to the hormonal physiology of labor 30 Hormonal responses and gender 30 "Fight¿or¿flight" and "tend¿and¿befriend" responses to distress and fear during labor 31 Optimizing the environment for birth 32 The psychöemotional state of the pregnant person: wellbeing or distress? 33 Pain versus suffering 33 Assessment of pain and coping 34 Emotional dystocia 34 Psychöemotional measures to reduce suffering, fear, and anxiety 34 Before labor, what the caregiver can do 34 During labor: tips for caregivers and doulas, especially if meeting the laboring client for the first time in labor 37 Conclusion 38 References 38 Chapter 4: Assessing Progress in Labor 41Wendy Gordon, DM, MPH, CPM, LM, with contributions by Gail Tully, BS, CPM, andLisa Hanson, PhD, CNM, FACNM, FAAN Before labor begins 42 Fetal presentation and position 42 Abdominal contour 42 Location of the point of maximum intensity (PMI) of the fetal heart tones via auscultation 42 Leopold's maneuvers for identifying fetal presentation and position 46 Abdominal palpation using Leopold's maneuvers 46 Estimating engagement: The rule of fifths 49 Malposition 53 Other assessments prior to labor 53 Estimating fetal weight 53 Assessing the cervix prior to labor 54 Assessing prelabor 55 Six ways to progress 55 Assessments during labor 55 Visual and verbal assessments 55 Hydration and nourishment 55 Psychology 56 Quality of contractions 56 Vital signs 57 Purple line 58 Assessing the fetus 58 Fetal movements 58 Gestational age 58 Meconium 59 Fetal heart rate (FHR) 59 Internal assessments 67 Vaginal examinations: indications and timing 68 Performing a vaginal examination during labor 68 Assessing the cervix 69 Assessing the presenting part 70 Identifying those fetuses likely to persist in an OP position throughout labor 75 The vagina and bony pelvis 76 Putting it all together 76 Assessing progress in the first stage 76 Features of normal latent phase 76 Features of normal active phase 76 Assessing progress in the second stage 77 Features of normal second stage 77 Conclusion 77 References 77 Chapter 5: Role of Physiologic and Pharmacologic Oxytocin in Labor Progress 82Elise Erickson, PhD, CNM, FACNM and Nicole Carlson, PhD, CNM, FACNM, FAAN History of oxytocin discovery and use in human labor 83 Structure and function of oxytocin 83 Oxytocin receptors 83 Oxytocin and spontaneous labor onset and progression 84 Promoting endogenous oxytocin function in spontaneous labor 85 Ethical considerations in oxytocin administration 85 Oxytocin use 86 Oxytocin use during latent phase labor 87 Oxytocin use during active phase labor 87 Oxytocin use during second stage labor 88 Changes in contemporary populations and labor progress 88 Oxytocin dosing 89 High dose/low dose 89 Variation in oxytocin dosing among special populations 89 Higher body mass index 89 Nullipara 90 Maternal age 90 Epidural 91 Problems associated with higher doses or longer oxytocin infusion 91 Postpartum hemorrhage 91 Fetal Intolerance to labor 92 Oxytocin holiday 92 Breastfeeding and beyond 92 New areas of oxytocin research 93 Conclusion 93 References 93 Chapter 6: Prolonged Prelabor and Latent First Stage 101Ellen L. Tilden, PhD, RN, CNM, FACNM, Jesse Remer, BS, CD(DONA),BDT(DONA), LCCE, FACCE, and Joyce K. Edmonds, PhD, MPH, RN The onset of labor: key elements of recognition and response 102 Defining labor onset 102 Signs of impending labor 103 Prelabor 103 Prelabor vs labor: the dilemma 103 Delaying latent labor hospital admissions 103 Anticipatory guidance 104 Anticipatory guidance for coping prior in prelabor 105 Sommer's New Year's Eve technique 106 Prolonged prelabor and the latent phase of labor 106 Fetal factors that may prolong early labor 107 Optimal fetal positioning: prenatal features 107 Miles circuit 109 Support measures for pregnant people who are at home in prelabor and the latent phase 110 Some reasons for excessive pain and duration of prelabor or the latent phase 111 Iatrogenic factors 112 Cervical factors 112 Management of cervical stenosis or the "zipper" cervix 112 Other soft tissue (ligaments, muscles, fascia) factors 112 Emotional dystocia 113 Troubleshooting Measures for Painful Prolonged Prelabor or Latent Phase 113 Measures to Alleviate Painful, Non¿progressing, Non¿dilating Contractions in Prelabor or Latent Phase 114 Synclitism and asynclitism 114 Open knee-chest position 118 Closed knee-chest position 119 Side¿lying release 119 When progress in prelabor or latent phase remains inadequate 120 Therapeutic rest 120 Nipple stimulation 120 Membrane sweeping 121 Artificial rupture of membranes in latent labor 121 Can prenatal actions prevent some postdates pregnancies, prolonged prelabors, or early labors? 121 Prenatal preparation of the cervix for dilation 121 References 125 Chapter 7: Prolonged Active Phase 130Amy Marowitz, DNP, CNM What is active labor? Description, definition, diagnosis 131 When is active labor prolonged or arrested? 131 Possible causes of prolonged active labor 132 Treatment of prolonged labor 132 Fetopelvic factors 132 How fetal malpositions and malpresentation delay labor progress 134 Determining fetopelvic relationships 134 Malpositions 134 Malpresentations 134 Use of ultrasound 135 Artificial rupture of the membranes (amniotomy) when there is a fetal malposition or malpresentation 135 Epidural analgesia and malposition or malpresentation 135 Maternal positions and movements for suspected malposition, malpresentation, or any "poor fit" 136 Overview and evidence 136 Positions to encourage optimal fetal positioning 137 Forward¿leaning positions 137 Side¿lying positions 137 Asymmetrical positions and movements 137 Abdominal lifting 142 "Walcher's" position 142 Flying cowgirl 142 Low technology clinical approaches to alter fetal position 144 Digital or manual rotation of the fetal head 144 Digital rotation 145 Manual rotation 146 Early urge to push, cervical edema, and persistent cervical lip 147 Manual reduction of a persistent cervical lip 148 Reducing swelling of the cervix or anterior lip 148 Disruptions to the hormonal physiology of labor 150 Overview 150 If emotional dystocia is suspected 150 Predisposing factors theorized to contribute to emotional dystocia 151 Possible indicators of emotional dystocia during active labor 151 Measures to help cope with expressed fears 151 Hypocontractile uterine activity 152 Factors that can contribute to contractions of inadequate intensity and/or frequency 152 Immobility 152 Environmental and emotional factors 152 Uterine lactate production in long labors 152 Sodium bicarbonate 153 Calcium carbonate 154 When the cause of inadequate contractions is unknown 154 Breast stimulation 154 Walking and changes in position 154 Acupressure or acupuncture 154 Coping and comfort issues 155 Individual coping styles 155 Simkin's 3 Rs: Relaxation, rhythm, and ritual: The essence of coping during the first stage of labor 156 Hydrotherapy: Warm water immersion or warm shower 156 Comfort measures for back pain 156 Exhaustion 157 Sterile water injections 158 Procedure for subcutaneous sterile water injections 159 Hydration and nutrition 160 Conclusion 160 References 160 Chapter 8: Prevention and Treatment of Prolonged Second Stage of Labor 166Kathryn Osborne, PhD, CNM, FACNM and Lisa Hanson, PhD, CNM, FACNM, FAAN Definitions of the second stage of labor 167 Phases of the second stage of labor 167 The latent phase of the second stage 168 Evidence-based support during the latent phase of second stage labor 169 What if the latent phase of the second stage persists? 169 The active phase of the second stage 169 Physiologic effects of prolonged breath¿holding and straining 170 Effects on the birth giver 170 Effects on the fetus 170 Spontaneous expulsive efforts 171 Diffuse pushing 172 Second stage time limits 173 Possible causes and physiologic solutions for second stage dystocia 174 Position changes and other strategies for suspected occiput posterior or persistent occiput transverse fetuses 174 The use of supine positions 174 Why not the supine position? 176 Use of the exaggerated lithotomy position 177 Differentiating between pushing positions and birth positions 178 Knees together pushing 178 Leaning forward while kneeling, standing, or sitting 178 Squatting positions 178 Asymmetrical positions 180 Lateral positions 181 Supported squat or "dangle" positions 181 Other strategies for malposition and back pain 182 Early interventions for suspected persistent asynclitism 183 Positions and movements for persistent asynclitism in second stage 188 Nuchal hand or hands at vertex delivery 190 If cephalopelvic disproportion or macrosomia ("poor fit") is suspected 190 The influence of time on cephalopelvic disproportion 191 Fetal head descent 191 Verbal support of spontaneous bearing¿down efforts...