Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines.

BACKGROUND: Guidelines for management of the second stage have been proposed since the 1800s and were created largely by expert opinion. Current retrospective data are mixed regarding differences in maternal and neonatal outcomes with a prolonged second stage. There are no randomized controlled trials that have evaluated whether extending the second stage of labor beyond current American College of Obstetricians and Gynecologists recommendations is beneficial. OBJECTIVE: The purpose of this study was to evaluate whether extending the length of labor in nulliparous women with prolonged second stage affects the incidence of cesarean delivery and maternal and neonatal outcomes. STUDY DESIGN: We conducted a randomized controlled trial of nulliparous women with singleton gestations at 36 0/7 to 41 6/7 weeks gestation who reached the American College of Obstetricians and Gynecologists definition of prolonged second stage of labor, which is 3 hours with epidural anesthesia or 2 hours without epidural anesthesia. Women were assigned randomly to extended labor for at least 1 additional hour, or to usual labor, which was defined as expedited delivery via cesarean or operative vaginal delivery. The exclusion criteria were intrauterine fetal death, planned cesarean delivery, ageyears, and suspected major fetal anomaly. Primary outcome was incidence of cesarean delivery. Maternal and neonatal outcomes were compared secondarily. Statistical analysis was done by intention-to-treat. RESULTS: Seventy-eight nulliparous women were assigned randomly. All of the women had epidural anesthesia. Maternal demographics were not significantly different. The incidence of cesarean delivery was 19.5% (n = 8/41 deliveries) in the extended labor group and 43.2% (n = 16/37 deliveries) in the usual labor group (relative risk, 0.45; 95% confidence interval, 0.22-0.93). The number needed-to-treat to prevent 1 cesarean delivery was 4.2. There were no statistically significant differences in maternal or neonatal morbidity outcomes. CONCLUSION: Extending the length of labor in nulliparous women with singleton gestations, epidural anesthesia, and prolonged second stage decreased the incidence of cesarean delivery by slightly more than one-half, compared with usual guidelines. Maternal or neonatal morbidity were not statistically different between the groups; however, our study was underpowered to detect small, but potentially clinical important, differences

Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya.

BACKGROUND: In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. METHODS: This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2-6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. RESULTS: Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others\u27 perspectives on delivery location and lack of aides/escorts. CONCLUSIONS: Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women\u27s preferences

The stress of fathers during the labor and delivery of their partner

This descriptive, retrospective survey employed a questionnaire to determine what factors cause stress to expectant fathers during their partner\u27s labor and delivery and how that stress is exhibited. Fathers of healthy newborns at two hospitals in Utah accompanying their partner in labor and delivery were asked to complete the questionnaire within 36 hours after the birth of their baby. The survey elicited responses from three different time periods during the labor and delivery: (1) the beginning of labor; (2) labor from the time of admission to the hospital and when labor reached its peak until delivery; and (3) during the delivery of the infant. The research data was analyzed utilizing four statistical techniques: (1) descriptive methods; (2) chi square; (3) Kendalls tau; and (4) MANOVA. The results of the study suggest that there were several stressors experienced by fathers during their partners\u27 labor and delivery. The stress reaches its peak during the second time period studied, peak labor, and dropped during the delivery of the infant. The study also identified actions that help fathers to cope and addressed relationships between stress experienced during labor and delivery and several demographic and other influencing variables

The Pope John Center: Labor, Delivery and the First Decade

Roll 26. Lodger's Caroling / Fr. Klubertanz. Image 1 of 7. (18 December, 1952; 22 December, 1952) [PHO 1.26.6]The Boleslaus Lukaszewski (Father Luke) Photographs contain more than 28,000 images of Saint Louis University people, activities, and events between 1951 and 1970. The photographs were taken by Boleslaus Lukaszewski (Father Luke), a Jesuit priest and member of the University's Philosophy Department faculty

Recent Trends in Term Trial of Labor After Cesarean by Number of Prior Cesarean Deliveries

BACKGROUND: Cesarean delivery is a major source of maternal morbidity, and repeat cesarean delivery accounts for 40% of cesarean delivery, but recent data on the trial of labor after cesarean and vaginal birth after cesarean are limited. OBJECTIVE: This study aimed to report the national rates of trial of labor after cesarean and vaginal birth after cesarean by number of previous cesarean deliveries and examine the effect of demographic and clinical characteristics on these rates. STUDY DESIGN: This was a population-based cohort study using the US natality data files. The study sample was restricted to 4,135,247 nonanomalous singleton, cephalic deliveries between 37 and 42 weeks of gestation, with a history of previous cesarean delivery and delivered in a hospital between 2010 and 2019. Deliveries were grouped by number of previous cesarean deliveries (1, 2, or ≥3). The trial of labor after cesarean (deliveries with labor among deliveries with previous cesarean delivery) and vaginal birth after cesarean (vaginal deliveries among trial of labor after cesarean) rates were computed for each year. The rates were further subgrouped by history of previous vaginal delivery. Year of delivery, number of previous cesarean deliveries, history of previous cesarean delivery, age, race and ethnicity, maternal education, obesity, diabetes mellitus, hypertension, inadequate prenatal care, Medicaid payer, and gestational age were examined concerning the trial of labor after cesarean and vaginal birth after cesarean using multiple logistic regression. SAS software (version 9.4) was used for all analyses. RESULTS: The trial of labor after cesarean rates increased from 14.4% in 2010 to 19.6% in 2019 ( CONCLUSION: More than 80% of patients with a history of previous cesarean delivery deliver by repeat scheduled cesarean delivery. With vaginal birth after cesarean rates increasing among those who attempt a trial of labor after cesarean, emphasis should be put on safely increasing the trial of labor after cesarean rates

Transition into Parenthood and the Effects of Childbirth Education

Attitudes of primiparous women toward childbirth were studied longitudinally as they varied with the intervention of childbirth education classes before delivery; and as they varied with the experience of labor and deli very and having a baby in the home after delivery. An anxiety scale was used measuring anxiety toward labor, delivery, the parenthood role, and stress on the marriage relationship. Measurement on the anxiety scale was taken prior to childbirth education when primiparous mothers ranged from 4 months to 7-1/2 months gestation. Measurement II on the anxiety scale was taken after childbirth education, one month prior to delivery. Measurement III on the anxiety scale was taken one month following delivery . The sample consisted of primiparous women selected from two Childbirth Education Classes at the Logan L. D. S. Hospital, Logan, Utah, in September and October of 1974. The following numbers of women responded on each of the three questionnaires: Measurement I - 77 Measurement II - 69 Measurement III - 66 Total Matched sample including all three measurements - 56. H was found that anxiety toward delivery increased significantly alter childbirth education and as time for delivery drew nearer, while anxiety toward labor decreased slightly but not significantly. One month following delivery, however, anxiety decreased toward both labor and delivery, as was expected, but anxiety toward delivery decreased to a lower level than did anxiety toward labor. H appears that these primiparous women experience more anxiety toward delivery prior to the experience, but after experiencing labor and delivery, some feel more anxious about labor than about delivery. No difference was found between any of the three measures on anxiety toward the role of parent. The participation of husbands in labor and delivery was viewed by over 90 percent of these primiparous mothers as a positive factor, on all three measurements. Earlier in pregnancy, power to childbirth education on Measurement 1, a strong positive correlation was found between physical symptoms of pregnancy and overall anxiety level. However, this relationship seemed to disappear after childbirth education, one month prior to delivery on Measurement II. An analysis of variance showed significant variation in the anxiety or stress of the childbearing cycle on the marriage relationship with the highest stress being just prior to delivery

Lamaze prepared and non-formally prepared fathers : a comparative study of expectations and retrospections of the labor and delivery experience

This study explored the effect of Lamaze preparation on fathers' views of the childbirth experience. The purpose of the study was to determine whether there was a difference between the Lamaze prepared and the non-formally prepared fathers' expectations prior to the labor and delivery experience, and in their retrospections of the actual experience of labor and delivery. Four null hypotheses were tested: (1) There is no difference between the expectations and the retrospections of the labor and delivery experience for the Lamaze prepared father. (2) There is no difference between the expectations and the retrospections of the labor and delivery experience for the non-formally prepared father. (3) The Lamaze prepared father will have expectations of the labor and delivery experience no different from the non-formally prepared father. (4) The Lamaze prepared father will have retrospections of the actual labor and delivery experience no different from the non-formally prepared father. Twenty expectant fathers participated in the investigation. Fourteen fathers had attended Lamaze classes with their wives in preparation for childbirth, and six fathers had no formal preparation. All fathers accompanied their wives throughout labor and birth, and all met established criteria for inclusion in this study

The effect of obesity on the onset of spontaneous labor and scheduled delivery rates in term pregnancies

Objective: To determine the effect of obesity on the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes in term pregnancies. Material and methods: 242 obese and 244 non-obese pregnant women ≥37 gestational weeks were compared in terms of the onset of spontaneous labor, scheduled delivery rates and perinatal outcomes. Results: Obese pregnant women had statistically significantly lower onset of spontaneous labor and higher rates of scheduled delivery. No difference was determined in respect of the type of delivery, 1st and 5th minutes APGAR scores and the need for intensive care. Higher values of birth weight, large for gestational age, macrosomia, gestational diabetes mellitus and preeclampsia were determined in obese women. Conclusion: The onset of spontaneous labor rates in term obese pregnancies were lower and scheduled delivery rates were higher than in the non-obese pregnancies. However, more extensive studies are needed to better understand this relationship. Keywords: Pregnancy, Obesity, Delivery, Labor, Pregnancy outcome

TB87: Delivery Costs per Package on Wholesale Milk Routes: A Comparison of Two Methods of Cost Allocation

This study of milk delivery operations was undertaken to develop labor relatives for different packages and to compare unit costs of delivery computed by using these relatives. A principal issue was whether variable direct labor was a better measure than total direct labor for allocating costs to various packages. Delivery operations on milk routes were timed to determine the amount of labor used in performing various functions in serving wholesale customers. This route information and the financial information on dealer delivery operations comprised the data base for the analyses.https://digitalcommons.library.umaine.edu/aes_techbulletin/1116/thumbnail.jp