![]() More experienced obstetricians often will perform examinations every 2 to 3 hours, depending on the presentation of the patient. ![]() Early in their training, residents should be encouraged and allowed to perform examinations hourly so that full educational opportunities are gained. Cervical examinations should be performed periodically to confirm that progress is being made. ![]() In the second stage of labor, from complete dilation until delivery, again one can anticipate the laboring woman gaining a minimum of 1 cm of station of the fetal head in relation to the maternal pelvis per hour. The deceleration phase likely is an aberration of the mathematic analysis of Friedman’s original data and as such is likely not a physiologic event. In the active phase, a minimum of 1 cm of dilation per hour can be anticipated ( Table 24.2). The cervix usually is effaced and <4 cm dilated. The acceleration phase occurs when the active phase of labor starts. The first stage of labor is divided into the acceleration phase, active phase, and deceleration phase. This curve was developed by Emanuel Friedman based on the observation of several thousand laboring women. The normal labor curve is shown in Figure 24.2. With fewer inductions of labor and improved management of labor, a decline in the cesarean delivery rate can be expected. This fundamental lack of understanding often leads to unnecessary induction of labor, which has an a priori risk of cesarean delivery of at least 25%, or to inadequate augmentation of abnormal labor. One reason for the continued high rate of cesarean delivery is a poor understanding of the labor process and the lack of an organized approach to the management of labor. An expanded definition advanced by Bowes is that dystocia is “any complication or circumstance that interferes with the progress of labor and vaginal delivery that endangers mother or fetus.” Most authorities agree that the number of cesarean deliveries remains excessively high. ![]() Dystocia, translated, means “difficult birth” and includes all abnormalities that may occur in women during labor. The four primary indications for cesarean delivery include dystocia, elective repeat cesarean delivery, fetal distress, and abnormal fetal presentation. From 1970 to 2005, the cesarean delivery rate in the United States increased from 5% to 30%. ![]()
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