Proponents of walking report that it shortens labor, lowers rates of oxytocin augmentation, diminishes the need for analgesia, and decreases the frequency of operative vaginal delivery (Flynn, 1978; Read, 1981). In their Cochrane review, Lawrence and associates (2013) found that labor in ambulant or upright positions shortened irst-stage labor by about 1 hour and lowered cesarean delivery and epidural analgesia rates. Lupe and Gross (1986) concluded, however, that no conclusive evidence supports assertions that upright maternal posture or ambulation improves labor. hey reported that women preferred to lie on their side or sit in bed. Few chose to walk, fewer to squat, and none wanted the knee-chest position. Parturients tended to assume fetal positions in later labor. Most women enthusiastic about ambulation returned to bed when active labor began (Carlson, 1986; Williams, 1980).
Bloom and colleagues (1998) conducted a randomized trial to study the efects of walking during irst-stage labor. In 1067 women with uncomplicated term pregnancies delivered at Parkland Hospital, these investigators reported that ambulation did not afect labor duration. mbulation did not reduce the need for analgesia, nor was it harmul to the newborn. Because of these observations, we give women without complications the option to select either recumbency or supervised mbulation during labor.
Rupture of Membranes
If the membranes are intact, temptation is great, even during normal labor, to perform amniotomy. The presumed beneits are more rapid labor, earlier detection of meconium-stained amnionic luid, and the opportunity to apply an electrode to the fetus or insert a pressure catheter into the uterine cavity for monitoring. he advantages and disadvantages of amniotomy are discussed in Chapter 26 (p. 511). Importantly, the fetal head must be well applied to the cervix and not be dislodged from the pelvis during the procedure to avoid umbilical cord prolapse.
In cases with prolonged membrane rupture, deined as greater than 18 hours, antimicrobial administration for prevention of group B streptococcal infections is recommended. his is discussed in Chapter 64 (p. 1221). his practice similarly lowers rates of chorioamnionitis and endometritis (Saccone, 2015).
Distention of the bladder can hinder descent of the fetal presenting part and lead to subsequent bladder hypotonia and infection. Periodically during labor, the suprapubic region is inspected and palpated to detect distention. If the bladder is readily seen or palpated above the symphysis, the woman should be encouraged to void. At times, those who may be unable to void on a bedpan may be able to ambulate with assistance to a toilet and successfully void. If the bladder is distended and voiding is not possible, catheterization is indicated. Carley and coworkers (2002) found that 51 of 11,332 vaginal deliveries (1 in 200) were complicated by postpartum urinary retention. Most women resumed normal voiding before discharge from the hospital. Musselwhite and associates (2007) reported retention in 4.7 percent of women who had labor epidural analgesia. Risk factors for retention were primiparity, oxytocin-induced or augmented labor, perineal lacerations, operative vaginal delivery, catheterization during labor, and labor durationi> 10 hours.
• Management of Second-Stage Labor