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PubMed1984

Local labor markets, children and labor force participation of wives.

Most research on married women's labor force participation relates characteristics of individual women to their probability of labor force participation. Some studies relate characteristics of geographic areas to average labor force participation rates in those areas, although these aggregate level analyses are usually gross tests of ideas about individual-level processes. Here we take a quintessentially sociological perspective and seek to understand how characteristics of geographic areas structure the relationship between properties of individual women and their probabilities of labor force participation. Our analysis has two steps. In step one, we fit individual-level probit models of married women's probability of labor force participation. A separate model is fitted in each of 409 areas using 1970 Census data, and the relationship between individual characteristics and labor force participation is found to vary substantially across areas. In step two, we attempt to explain areal variation in the effects of women's children on their labor force participation. We hypothesize that the effect of children on their mothers' labor force participation is a function of the cost and availability of childcare , and of the "convenience" of jobs for working mothers in the places where the mothers live. Measures of childcare cost, childcare availability and job convenience are developed. Weighted least squares analyses of probit coefficients from the first stage are, in general, very consistent with our findings, and suggest that the approach taken in this paper is likely to be a fruitful one for future studies.

Adolescent↗
PubMed1996

The presence of fetal fibronectin in the cervicovaginal secretions of women at term--its role in the assessment of women before labor induction and in the investigation of the physiologic mechanisms of labor.

OBJECTIVE: Our purpose was to determine whether the presence of fetal fibronectin in cervicovaginal secretions of patients undergoing induction of labor reflected the cervical state and ultimately the ease of induction of labor. STUDY DESIGN: A prospective observational study of 103 patients undergoing induction of labor at term was conducted at Liverpool Maternity Hospital, a large university teaching hospital. We studied the women after 37 completed weeks of pregnancy. A Dacron (Adeza Biomedical, Sunnyvale, Calif.) polyester swab specimen was first taken from the endocervix for assessment of the presence of the fetal fibronectin. The cervix was then assessed by digital vaginal examination and scored with a modified Bishop's score. The fetal fibronectin swab was processed at the bedside with a membrane immunoassay kit specific for fetal fibronectin. A score was ascribed depending on the strength of the fibronectin reaction determined by the intensity of the color change on the plate, the presence of fetal fibronectin resulting in a score of 1 to 4. The patient was subsequently managed according to the standard induction protocol of the unit. The clinicians involved in the patient's care were blind to the result of the fetal fibronectin swab. RESULTS: There was a good correlation between the modified Bishop's score and the fetal fibronectin score (r = 0.58, p < 0.001). To predict a latent phase of < 8 hours, a fetal fibronectin score of 3 or 4 has a sensitivity of 73% with a specificity of 83% and a modified Bishop score of > or = 4 has a sensitivity of 75% and a specificity of 73%. For delivery within 12 hours of induction of labor a fetal fibronectin score of > or = 3 has a sensitivity of 61% and specificity of 83% compared with the modified Bishop score of > or = 4, which has a sensitivity of 76% and a specificity of 72.5%. CONCLUSIONS: The fetal fibronectin score is as good as the modified Bishop score as an index of the ease with which induction of labor may be performed. This would imply that it also reflects the proximity of the onset of labor. The presence of fetal fibronectin cervicovaginal secretions is therefore a marker of the changes in the cervix and membranes that precede labor regardless of the gestational age.

Adolescent↗
PubMed2001

Should we allow a trial of labor after a previous cesarean for dystocia in the second stage of labor?

OBJECTIVE: To estimate the rate of successful vaginal birth including operative vaginal delivery in patients with a previous cesarean for cephalopelvic disproportion in the second stage of labor. METHODS: Data from all patients who underwent trial of labor after a previous cesarean between 1990 and 2000 at our tertiary care institution were analyzed. Medical records were reviewed and data collected for the following variables: indication for the previous cesarean, birth weight and cervical dilatation at previous cesarean delivery, as well as the mode of delivery (spontaneous, vacuum, forceps, cesarean) and the birth weight for the subsequent pregnancy. Pearson's chi(2) test and one-way analysis of variance were used for statistical analyses. RESULTS: There were 2002 patients included in the study. Two hundred fourteen (11%) had their previous cesarean for dystocia in the second stage of labor, 654 (33%) for dystocia in the first stage of labor, and 1134 (57%) for other indications. The vaginal birth after cesarean success rate was 75.2% (P = .015 vs other indications), 65.6% (P < .001 vs other indications), and 82.5%, respectively. The rate of operative vaginal delivery was 15%, 12%, and 10% (P = .109). CONCLUSION: A trial of labor is reasonable in women whose previous cesarean was for dystocia in the second stage of labor. In this series, patients who underwent a trial of labor after a previous cesarean for dystocia in the second stage had 75.2% (95% confidence interval 69.5, 81.0) chance of achieving vaginal delivery.

Adult↗
PubMed2002

The labor curve of the grand multipara: does progress of labor continue to improve with additional childbearing?

OBJECTIVE: Our purpose was to test the hypothesis that progress of labor slows as parity exceeds 4 by comparing labor curves of grand multiparous women (para 5 and over) (GMs) with those of nulliparous and lower-parity multiparous women. STUDY DESIGN: Retrospective cohorts of spontaneously laboring, vertex-presenting, term GMs who were admitted to two medical centers during the period from January 1990 through June 1995 were randomly computer-matched to a nulliparous and a lower-parity multiparous control subject, matched for age, hospital, and year of delivery. Cervical examination data were graphed retrospectively from the time of full dilatation. Curves were compared by pairwise likelihood ratio tests, by using a random effects model to adjust for obstetric interventions, with significance set at P <.05. RESULTS: Pregnancies in 1095 GMs, 1174 lower-parity multiparous women, and 908 nulliparous women were studied. GMs exhibit a longer initial phase of labor than either nulliparous women or lower-parity multiparous women, begin to dilate rapidly at a greater dilatation than nulliparous women, and experience acceleration of labor at a rate no faster than lower-parity multiparous women. The average labor curve of GMs resembles that of nulliparous women before dilatation of 4 cm is attained, then transitions to the typical curve of the lower-parity multiparous women until dilatation of 6 cm is attained and thereafter is indistinguishable from that of the lower-parity multiparous women (P <.001). CONCLUSIONS: Once parity exceeds 4, progress of labor slows. "Poor progress" beyond dilatation of 4 cm should not be considered abnormal for a GM, because she is likely still in the latent phase until dilatation of 6 cm is attained. Nor should she be expected to progress through her active phase any faster than lower-parity multiparous women.

Adult↗
PubMed2003

Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor.

Acupressure is said to promote the circulation of blood and qi, the harmony of yin and yang, and the secretion of neurotransmitters, thus maintaining the normal functions of the human body and providing comfort. However, there has been little research-based evidence to support the positive effects of acupressure in the area of obstetric nursing. The purpose of this study is to determine the effect of LI4 and BL67 acupressure on labor pain and uterine contractions during the first stage of labor. An experimental study with a pretest and posttest control group design was utilized. A total of 127 parturient women were randomly assigned to three groups. Each group received only one of the following treatments, LI4 and BL67 acupressure, light skin stroking, or no treatment/conversation only. Data collected from the VAS and external fetal monitoring strips were used for analysis. Findings indicated that there was a significant difference in decreased labor pain during the active phase of the first stage of labor among the three groups. There was no significant difference in effectiveness of uterine contractions during the first stage of labor among the three groups. Results of the study confirmed the effect of LI4 and BL67 acupressure in lessening labor pain during the active phase of the first stage of labor. There were no verified effects on uterine contractions.

Acupressure↗
PubMed1977

Amniotic fluid cortisol concentrations in normal labor, premature labor, and postmature pregnancy.

Amniotic fluid cortisol concentration was measured in 61 gravidas during the third trimester prior to onset of labor. These patients had had normal prenatal courses and served as controls. Cortisol values obtained were compared with those of 1) gravidas with prolonged pregnancy (greater than 42 weeks) who delivered post-mature neonates (N=6), 2) gravidas in spontaneous term labor (N = 10), and 3) gravidas in premature labor (N=10). The mean level of amniotic fluid cortisol (+/-SD) found in those women with premature labor was significantly elevated compared to control values (P less than 0.05). Levels recorded in premature labor patients were in the same range as in the term spontaneous labor group (3.7+/-2.5 vs. 2.7+/-1.5; P greater than 0.3). No difference was found between the spontaneous labor group or the postmature group and their respective controls.

Amniotic Fluid↗
PubMed1994

Transvaginal ultrasonographic evaluation of the cervix before labor: presence of cervical wedging is associated with shorter duration of induced labor.

OBJECTIVE: Our purpose was to test the hypothesis that transvaginal ultrasonographically determined characteristics of the cervix are associated with duration of induced labor. STUDY DESIGN: Fifty-three patients scheduled for induction of labor underwent transvaginal ultrasonography and digital cervical examinations before labor induction. Cox proportional-hazards multiple regression analysis was performed to determine the variables that made a significant contribution to the prediction of latent-phase and total labor duration. In the analysis the possible confounding effects of exogenous prostaglandin, previous vaginal delivery, and previous termination of pregnancy were controlled. RESULTS: Latent-phase and total labor duration were significantly associated with the presence of cervical wedging noted on transvaginal ultrasonography and administration of prostaglandin but not with the result of digital examination of cervical effacement or dilatation. Latent-phase duration was also associated with cervical length measured by transvaginal ultrasonography. The presence of wedging was significantly associated with shorter latent (15.9 +/- 1.7 vs 34.1 +/- 3.8 hours, p = 0.0001) and total (22.0 +/- 1.8 vs 38.3 +/- 3.6 hours, p = 0.0001) labor length. CONCLUSION: The presence of wedging and decreased cervical length observed by transvaginal ultrasonography is associated with a shorter duration of induced labor and may be useful in the evaluation of induction candidates.

Adult↗
PubMedDate not supplied

Natural eating behavior in latent labor and its effect on outcomes in active labor.

This study examined the effect of eating during the latent phase of labor on the hospital-estimated labor duration and birth outcomes for the mother and baby. A prospective, comparative trial with concurrent controls compared labor duration and outcomes of 176 low-risk, nulliparous women who birthed at four hospitals in Sydney, Australia. Food was voluntarily consumed by 82 women, whereas 94 consumed clear fluids only. Food intake during the latent phase of the first stage of labor was associated with a longer duration of labor (mean difference = 2.35 hours). No difference was found between eating and noneating groups for the rate of medical interventions, adverse birth outcomes, or vomiting. Results suggest that eating during the latent phase of labor may increase labor duration.

Adult↗
PubMed1986

Peasants in reserve: temporary West Indian labor in the U.S. farm labor market.

In the past 10 years, the British West Indies Temporary Alien Labor Program has received widespread judicial and legislative support and criticism. While sugar and apple producers who import West Indians argue that domestic labor is insufficient to harvest their crops, labor organizations and their supporters maintain that domestic labor is adequate. The resulting labor disputes focus primarily on the issue of whether or not West Indians are displacing US workers or undermining wage rates and working conditions. This article examines the relationships among legal issues surrounding the program, the US farm labor market, and the Jamaican peasantry. It argues that continued imports of foreign labor during times of high domestic unemployment, as well as the varied factors which underlie the continued willingness and ability of Jamaican peasant households to supply workers to US producers, can be most clearly understood from an international and historical perspective, rather than focussing on the needs and problems of any 1 nation.

Agriculture↗
PubMed1985

Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern.

The duration of labor in multigravid subjects in phase 1 labor at term (from 3 to 6 cm of cervical dilatation; mean duration = 2.7 hours) was significantly related to measures of plasma epinephrine and norepinephrine obtained at the onset of the phase (n = 50). Epinephrine was significantly related to observer ratings of subject stress and the scores from the three dimensions of our self-report Labor Anxiety Inventory. The fetal heart rate pattern in phase 2 labor (7 to 10 cm of cervical dilatation; mean duration = 1.2 hours) was significantly related to phase 1 measures of epinephrine, observed stress, and two of the anxiety dimensions (n = 44 to 47). The results provide support for the hypotheses that, under normal clinical conditions, several types of patient anxiety are related to catecholamine levels and that anxiety and epinephrine are related to duration of labor and fetal well-being. The results suggest that medical/nursing evaluation and management of patient anxiety should include a self-report measure of three dimensions of anxiety (coping, safety, and pain), which are relatively independent of observed physical stress and which may relate to maternal labor progress as well as fetal heart rate pattern.

Adult↗
PubMedDate not supplied

A randomized controlled trial of oxytocin administered at the end of the second stage of labor versus oxytocin administered at the end of the third stage of labor in the prevention of postpartum hemorrhage.

The general objective was to determine the incidence of postpartum hemorrhage when oxytocin was administered at the end of the second stage of labor compared to when oxytocin was administered at the end of the third stage. The specific objectives were to determine the mean amount of blood loss, duration of the third stage of labor, need for additional uterotonics and blood transfusion, incidence of hypotension and retained placenta, and mean difference in hemoglobin levels. A randomized controlled trial was conducted in a tertiary care training hospital. 130 women with term, singleton, live pregnancies in cephalic presentation who delivered vaginally were included. Patients were randomly allocated to receive oxytocin after the second stage or after the third stage of labor. Oxytocin was administered as a continuous intravenous infusion. The placenta was delivered by controlled cord traction after placental separation. Blood loss was measured by weight, and the corresponding volume was computed. Relative risk was calculated. Incidence of postpartum hemorrhage, volume of blood loss, duration of the third stage of labor, need for additional uterotonics and blood transfusion, incidence of hypotension and retained placenta, and difference in hemoglobin levels were the main outcome measures. There was a decreased incidence of postpartum hemorrhage (39.66% vs. 48.61%, relative risk [RR] = 0.82, 95% confidence interval [CI] = 0.55-1.21) and less amount of blood loss (557.93 ml vs. 636.84 ml, p = 0.352) when oxytocin was administered at the end of the second stage of labor. There was less need for additional uterotonics (12.07% vs. 13.89%, RR = 0.87, 95% CI = 0.35-2.14), and blood transfusion (5.17% vs. 5.56%, RR = 0.87, 95% CI = 0.22-3.99). There was a smaller mean difference in hemoglobin (16.20 g/dl vs. 20.29 g/dl, p = 0.145). Mean duration of the third stage of labor were comparable (7.93 minutes vs. 7.96 minutes, p = 0.863). However, more patients developed hypotension (3.45% vs. 1.39%, RR = 2.48, 95% CI = 0.23-26.70). All results were not statistically significant. There was no incidence of retained placenta. There is a trend towards a reduction of the risk of postpartum hemorrhage when oxytocin is administered at the end of the second stage of labor. This is not accompanied by an increased risk for any morbidity.

Asia↗
PubMedDate not supplied

Prostaglandin endoperoxide synthase kinetics in human amnion before and after labor at term and following preterm labor.

To determine whether the kinetics of prostaglandin endoperoxide synthase (PGHS, commonly known as cyclooxygenase) in human amnion change with labor onset or between preterm and term labor, a specific enzyme assay was developed and characterized. The assay was linear for time (0-8 min) and protein concentration (5-30 micrograms/250 microliters incubation volume). The optimum pH was 8.0-8.5, and the enzyme reaction reached saturation at 10-20 microM arachidonic acid. Flufenamic acid was more efficacious than ibuprofen in the presence of 1 mM tryptophan in inhibiting enzyme activity. The Km and Vmax of PGHS were determined in 10 amnions obtained at elective caesarean section before labor onset (CS) at 39.3 +/- 0.8 wk gestational age (mean +/- SD, range = 38.5-41 wk) and 9 amnions obtained following spontaneous labor and vaginal delivery (SL) at 39.6 +/- 0.8 wk (range = 38.5-41 wk). The Km values were 1.4 +/- 1.2 mumol/l (CS) and 2.2 +/- 1.5 mumol/l (SL) (not different). However, the Vmax increased significantly (p < 0.05) from 11 +/- 8 (CS) to 19 +/- 4 (SL) pg PGE2/micrograms protein/min. In eight preterm amnions obtained following spontaneous labor and delivery at 32.9 +/- 2.1 wk (range = 29-36 wk), the Km and Vmax were 2.0 +/- 1.2 mumol/l and 17 +/- 9 pg PGE2/micrograms protein/min, respectively. Neither of these values was different from those of CS or SL amnions. None of the preterm pregnancies displayed histological evidence of infection. These results suggest that an increase in the mean amnion PGHS maximum velocity occurs in association with the onset of labor at term. The mean Vmax of PGHS in amnions obtained from idiopathic preterm spontaneous deliveries is between the CS and SL term values, reflecting, perhaps, multiple etiologies for preterm delivery.

Amnion↗
PubMed1991

Spurious labor: a high risk factor for dysfunctional labor and fetal distress.

This is a retrospective case controlled study comparing the outcome of labor and neonates in pregnancies complicated by spurious labor at term. The first stage of labor was significantly longer and the proportion of cases requiring oxytocin augmentation was higher in the study group when compared to the controls. More infants in the study group displayed intrapartum CTG abnormalities and five had a depressed Apgar score at 5 min, compared to none in the controls. Of these five neonates, three were admitted to the neonatal intensive care unit and one died from meconium aspiration syndrome and asphyxia. The findings in this study support the view that spurious labor at term constitutes a high risk factor for the ensuing labor.

Adult↗
PubMed1976

Simultaneous comparison of delta 5-3beta-hydroxysteroid levels in the fetoplacental circulation of normal pregnancy in labor and not in labor.

Concentrations of pregnenolone (delta5P), dehydroepiandrosterone (DHEA), 16alpha-hydroxydehydroepiandrosterone (16alpha-OH DHEA), pregnenolone sulfate (delta5P-S), and dehydroepiandrosterone sulfate (DHEA-S) were measured simultaneously by radioimmunoassay in individual, paired umbilical artery (UA) and vein (UV) sera from 18 normal term pregnancies, 6 in labor, 12 not in labor. Mean UA and UV levels +/- SEM (ng/ml) were for delta5P: 30.39 +/- 1.69, 35.55 +/- 3.06; DHEA: 12.31 +/- 2.34, 3.66 +/- 0.38; 16alpha-OH DHEA: 7.48 +/- 0.63, 10.59 +/- 0.78; delta5P-S: 1,652 +/- 154, 1,486 +/- 130; DHEA-S: 2,122 +/- 134, +/- 134, 1,906 +/- 134. Umbilical artery delta5P-S, DHEA-S, and DHEA levels were significantly higher than UV levels, whereas the reverse was true for delta5P and 16alpha-OH DHEA. The inverse arterio-venous (A-V) gradient for 16alpha-OH DHEA was contrary to previous published reports using pooled samples. Comparison by linear regression of paired UA and UV steroid concentrations of delta5P, delta5P-S, DHEA, and DHEA-S revealed a significant correlation (P less than 0.01) for each steroid. Labor was associated with a significant increase in UA levels of DHEA-S and a smaller, but not quite significant, increase in UA levels of delta5P-S, while similar changes for unconjugated delta5-3beta-hydroxysteroids were not observed. Mean A-V gradients between the group of patients in labor and those not in labor were not significantly different. These data demonstrate that: 1) a significant difference between UA and UV concentrations exists for delta5P, DHEA, 16alpha-OH DHEA, delta5P-S, and DHEA-S; 2) there is a significant correlation between UA and UV concentrations for delta5P, DHEA, delta5P-S, and DHEA-S, implying that each fetoplacental unit maintains an equilibrium relative to these steroid concentrations in the umbilical circulation; 3) labor is associated with a significant increase in UA levels of DHEA-S and probably of delta5P-S.

Blood↗
PubMed1980

Early detection of abnormal labor using the Friedman labor graph.

Early recognition and appropriate management of abnormal labor can reduce perinatal mortality and morbidity and lower the cesarean section rate. A simple labor graph devised over 25 years ago and later modified makes labor abnormalities easy to detect; the two main divisions of labor, the latent and active phases, are easily recognized. A prolonged latent phase has no serious effects on mother or fetus, but protraction and arrest disorders of the active phase--eg, protracted cervical dilatation, arrest or failure of descent of the presenting part--may have a deleterious effect. Common causes of a prolonged latent phase include false labor and inappropriate use of analgesia and anesthesia. Fetopelvic disproportion and fetal malposition are common causes of disorders of the active phase.

Adolescent↗