Keep on learning

I forgot why I included this in the journal. I think I was talking out loud and we were discussing latent labor in class and when do you know when real labor begins.  In my doula experience, I usually encouraged moms to get to about 4cms and it was all downhill from there, whether it was factually based or not, is up to interpretation.  I also told them that contractions would get only so painful and then they would just get closer together but not anymore painful.  Maybe this is when those endorphins finally catch up and help the mom cope with labor? 

I think I found evidence to support my claim in Zhang et al research verifying most nulliparous women entering active phase between 3 cm and 5 cm.  Most clinicians use 4 cm as when active phase begins, but individual differences need to be accounted for like grand multips remaining in latent labor until 6 cms. We may further redefine false labor as prelabor, described as inefficient contractions not leading to cervical change.  Caregivers should ask women when their labor started and how they knew, rather than when regular contractions began.  Listen to mothers instead of applying arbitrary times and signs to identify onset of labor. 

One study found that women in prelabor actually experienced greater discomfort than women in labor. The diagnosis of labor can only be made with serial VE.  The risk associated with therapeutic rest is that it may prolong dysfunctional labor. Can offer moms 50mg of Benadryl to allow for therapeutic rest and progression of labor while the mother sleeps.  Hydration decreases pituitary secretion of antidiuretic hormone and oxytocin. Membrane sweeping has the potential to initiate labor by increasing local production of prostaglandins. Insufficient evidence to suggest that enemas or castor oil works as induction methods. Wine was used to stop labor until the 1960s. It may inhibit secretion of oxytocin by the posterior pituitary inhibiting contractions. Ethanol does pass through the placenta but is quickly eliminated by the newborn, but not without causing similar effects like morphine. AROM should be reserved for women with abnormal progress. PP hemorrhage and chorioamnionitis were more frequent in women who have longer latent phases. The majority of patients are in active-phase labor by the time the cervix reaches 4 cm, but many are not.