II. Management: General Measures

  1. Avoid early hospitalization in Latent Phase of Labor
    1. See Latent Phase of Labor for management
  2. Consider Structured Intermittent Auscultation (SIA)
    1. Preferred over Continuous Electronic Fetal Monitoring
    2. Consider using CEFM only in high risk pregnancies
  3. Informed Consent regarding Labor Anesthesia
    1. Epidural Anesthesia increases risk of ceserean
    2. Avoid epidural and intrathecal anesthesia until >4 cm
  4. Encourage ambulation
  5. Avoid induction if Cervix unripe if possible
    1. See Bishops Score
    2. See Cervical Ripening
  6. Antepartum labor classes (e.g. Lamaze)
    1. Patient Education on what to expect in labor
  7. Physician and nurse team impacts Labor Dystocia
    1. Be patient in slow progressing nullip
      1. DeMott (1992) Am J Obstet Gynecol 166:1799-810 [PubMed]
    2. Increased total contact time decreases ceserean rate
      1. Radin (1993) Birth 20:14-21 [PubMed]
  8. Encourage Doula use
  9. Amniotomy when in Active Phase of Labor
  10. Employ alternatives to labor Analgesics
    1. See Non-Pharmacologic Pain Control in Labor
  11. Consider high dose Oxytocin augmentation in nullips
    1. Decrease labor duration by 2 hours without added risk
    2. Merrill (1999) Obstet Gynecol 94:455-63 [PubMed]

III. References

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