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PubMed1990

The labor impacts of policy change in health care: how federal policy transformed home health organizations and their labor practices.

Health care organizations are highly labor-intensive; policies designed to stimulate organizational change are likely to have labor impacts. This paper examines the labor effects of policy change in home health care. Major federal home care policy trends since 1980 have spurred the evolution of the typical home care provider toward greater organizational and market rationality. Greater managerial sophistication has introduced changes in management/labor relations. Survey data from the 1986 DRG Impact Study are used to show how the pressure of cost-containment policies has pushed agencies to cut labor costs by increasing workloads, managerial supervision, and control of the work process. Research on the effects of recent policy change in health care has to date focused primarily on potential client effects. Labor impacts are rarely examined and are poorly understood at the time that policy is made. Findings in this article suggest that these issues deserve greater, more systematic attention, because unanticipated labor impacts may prove to be significant impediments to the realization of intended policy goals.

Allied Health Personnel↗

PubMed2003

[Effects of San-Yin-Jiao(SP6) acupressure on labor pain, delivery time in women during labor].

PURPOSE: The study was done to examine the effects of San-Yin-Jiao(SP6) acupressure treatment on subjective labor pain, length of delivery time in women during labor. METHOD: The study design was a randomized controlled clinical trial study using a double-blinded method. Data were collected using a structured questionnaire, a subjective labor pain scale and measurement of delivery time. The experimental group(n=29) was received SP6 acupressure and control group(n=29), SP6 touch for the duration of each uterine contraction, during 30 minutes after 3 cm dilatation of cervical os. RESULT: The subjective labor pain scores was significantly different between the two groups(p=0.042). The total length of delivery time in the group which had the SP6 acupressure was shorter than SP6 touch group (p=0.036). CONCLUSION: These findings showed that SP6 acupressure was effective related to labor pain, length of time for delivery. SP6 acupressure during labor could be applied as an effective nursing treatment.

Clinical Trial↗

PubMed1976

Carbohydrate and lipid metabolism during human labor: free fatty acids, glucose, insulin, and lactic acid metabolism during normal and oxytocin-induced labor for postmaturity.

This investigation was performed to study the metabolism of the major body fuels (viz. glucose and free fatty acids), insulin, and lactic acid during the stress of human labor. In addition, the role of the normal placenta in the transport of these substances between mother and the fetus was evaluated by measuring them in the mother and cord blood at delivery. To study possible alterations of this role in the placenta which had exceeded the normal period of gestation, a second comparable group of women had labor induced with oxytocin 16-18 days beyond the expected date of delivery. A dramatic twofold increase in maternal plasma free fatty acids was observed during labor. There was a lesser but definite increase in blood glucose concentrations. No rise in serum insulin levels was noted which coincided with the changes in blood glucose. Lactic acid concentrations during the course of labor were variable from baseline but at delivery, the concentrations rose to very significant levels. Free fatty acids and blood glucose levels were significantly higher in the maternal than in the fetal side. A significantly positive correlation was noted between the maternal and cord blood values except for free fatty acids in the postmature group. No significant difference, nor a correlation was found between the two compartments in the insulin nor lactic acid levels. These results suggest that during human labor free fatty acids are the principal metabolic fuel. This increase in maternal free fatty acids may serve to spare glucose as a metabolic fuel in the fetus. The mechanism responsible for the increase maternal free fatty acid mobilization remains to be determined. It is not possible to discern any consistant alteration in placental function as a consequence of prolonged gestation.

Adolescent↗

PubMed1988

Vaginal birth after cesarean section for arrest of labor: is success determined by maximum cervical dilatation during the prior labor?

The charts of 229 patients who attempted a vaginal birth after a cesarean section were reviewed. A total of 103 patients had a prior cesarean section for either failure to progress or cephalopelvic disproportion. On the basis of the maximum cervical dilatation in the prior labor, the patients were categorized into three groups: 0 to 5 cm, 6 to 9 cm, and 10 cm. The success rates for vaginal delivery of 61%, 80%, and 69%, respectively, were not significantly different among groups (p = 0.31). When arrest of labor was not the indication for primary cesarean section, 78% of the patients were subsequently delivered of their infants vaginally. This was not significantly different from the 70% overall success rate achieved by the group with failure to progress or cephalopelvic disproportion (p = 0.17). Similarly, when the success rate for a trial of labor was plotted against neonatal birth weight, the trends were comparable in the groups with and without failure to progress or cephalopelvic disproportion. These data suggest that patients with a prior cesarean section for arrest of labor are good candidates for a trial of labor and that the cervical dilatation previously reached does not determine the likelihood of success.

Birth Weight↗

PubMed1993

The squatting position for the second stage of labor: effects on labor and on maternal and fetal well-being.

A cohort study was designed to assess the effects of maternal squatting position for the second stage of labor on the evolution and progress of labor, and on maternal and fetal well-being. Outcomes from 200 squatting births, randomly selected from a sample of 1000, were compared with 100 semirecumbent births, randomly selected from a sample of 300. Data collection was by chart review. The two groups were similar with respect to most antepartal, intrapartal, and socioeconomic variables likely to affect labor outcomes. The mean length of the second stage of labor was 23 minutes shorter in squatting primiparas and 13 minutes shorter in squatting multiparas than in semirecumbent women. Squatting women required significantly less labor stimulation by oxytocin during second stage (P = 0.0016), and they showed a trend toward fewer mechanically assisted deliveries. Significantly fewer and less severe perineal lacerations occurred, and fewer episiotomies were performed in the squatting group (P = 0.0001). No statistically significant differences were found between groups for third-stage complications and infant complications.

Adult↗

PubMed2005

Up-regulation of the progesterone receptor (PR)-C isoform in laboring myometrium by activation of nuclear factor-kappaB may contribute to the onset of labor through inhibition of PR function.

Progesterone acting via the progesterone receptor (PR) plays a critical role in maintaining uterine quiescence during pregnancy. In the present study, we tested the hypothesis that the transactivating capability of the PR is down-regulated in the myometrium at term by a change in uterine PR isoform ratio resulting from local activation of the nuclear factor (NF)-kappaB pathway. Overexpression of the truncated PR-C isoform in human myometrial cells inhibited PR-B transactivation. Expression of PR isoforms, PR-A, PR-B, and PR-C, was characterized by immunoblotting and quantitative PCR (Q-PCR) in fundal and lower uterine segment myometrium from pregnant women in labor and not in labor and in the pregnant mouse uterus during late gestation. We observed a marked increase in levels of PR-C and transcriptionally active PR-B specifically in fundal myometrium of women in labor. In pregnant mouse uterus, levels of PR-B and PR-C also increased between 15 days post coitum and term, whereas expression of PR-A was dramatically up-regulated at 19 days post coitum. In studies of uterine tissues of mice injected intraamniotically with surfactant protein A and of human myometrial and T47D breast cancer cells in culture, up-regulation of PR isoform expression was observed in response to activation of the NF-kappaB pathway. Chromatin immunoprecipitation analysis revealed IL-1beta induced binding of NF-kappaB to the PR promoter. Collectively, these findings suggest that up-regulation of inhibitory PR isoform expression by NF-kappaB activation in both laboring human fundus and pregnant mouse uterus near term may inhibit PR transactivation and thereby lead to a loss of uterine quiescence and the onset of labor.

Animals↗

PubMed2005

[Effects of epidural ropivacaine labor analgesia on duration of labor and mode of delivery].

OBJECTIVE: To study the effects of ropivacaine on the duration of labor and mode of delivery in the primigravidas using patient-controlled epidural analgesia (PCEA). METHODS: Retrospective analysis was performed. The 190 healthy, full-term, and single-fetus parturient primigravidas who received PCEA with 0.1% ropivacaine + fentanyl (1 microg/ml) were in the epidural analgesia group. Another 222 primigravidas who did not receive PCEA were in the control group. The duration of labor and modes of delivery, and the neonatal Apgar scores in both two groups were recorded and evaluated. RESULTS: Those in the epidural analgesia group experienced a significantly longer first stage [(426 +/- 161) minutes], longer second stage [(54 +/- 27) minutes] and longer full duration of delivery [(489 +/- 166) minutes] than those in the control one [(409 +/- 170) minutes, (364 +/- 167) minutes and (37 +/- 22) minutes]. The rate of using pitocin in the epidural analgesia group (30.2%) was significantly higher than that in the control group (4.1%). The cesarean section rate in epidural analgesia group (20.0%) was lower than that in the control one (28.4%); while the rate of instrumental delivery in the epidural analgesia group (20.0%) was significantly higher than that in the control one (6.3%). In summary, there were significant differences between two groups in the duration of labor, the rate of using pitocin, the rate of instrumental delivery and the rate of cesarean section. But there were no differences found for those newborn who had Apgar scores less than 7 at the point of both one and five minutes (7.9% and 4.5%, 2.6% and 0.5% respectively). CONCLUSION: Epidural ropivacaine labor analgesia lengthens the duration of labor and increases the rate of instrumental delivery, but it has no significant negative effects on the neonates.

Adult↗

PubMed1986

Labor in humans: 1. Progesterone, 20 alpha-dihydro-progesterone, estrone and 17 beta-estradiol in near placental and most distant human amnion and chorion laeve in various stages of labor at term.

In some species the onset of labor is regulated by changes in the estrogen/progesterone ratio. The same change in fetal membranes has been suggested to be one of the triggering mechanisms of labor in humans. In order to examine if a gradient in steroid concentration existed in fetal membranes and if changes in concentrations could be observed with the onset and advancing labor, the concentration of progesterone (P), 20 alpha-dihydro-progesterone (20 alpha-OHP), estrone (E1) and 17 beta-estradiol (E2) were determined by specific radioimmunoassay in the near placental and most distant regions of human amnion and chorion laeve obtained at term, before, at the onset and in advanced labor. Both estrogen and progestin concentrations in the chorion were higher than in the amnion. No gradient in the concentration of steroids was found. No statistically significant differences in estrogen and progestin levels were associated with the onset of labor.

20-alpha-Dihydroprogesterone↗

PubMedDate not supplied

No free lunch on labor day. The risks and benefits of epidural analgesia during labor.

Epidural analgesia provides effective pain relief for women during labor. However, like all medical interventions, it also has potential side effects such as longer labor and a higher rate of intrapartum fever and operative vaginal delivery. A recent meta-analysis of randomized studies by Halpern et al concluded there was no association between epidural use and cesarean delivery. A critique of that meta-analysis, included in this paper, concludes that there are currently insufficient data to determine whether epidural analgesia leads to increased rates of cesarean delivery. This paper also presents results from several recent studies related to epidural analgesia conducted at Brigham and Women's Hospital in Boston. One study demonstrates a significant influence of prenatal planning on use of epidural during labor. Additional studies examine the strong association of epidural analgesia with intrapartum fever and the consequences of that fever for mother and infant. Epidural analgesia should remain an option available to women during labor. A more complete understanding of the risks and benefits that accompany its use is essential so that women and their care providers can make informed choices about pain relief during labor.

Analgesia, Epidural↗

PubMed2001

Labor admission test: an assessment of the test's value as screening for fetal distress in labor.

BACKGROUND: To determine if the labor admission test (LAT) can predict fetal distress in a population of laboring women, and in subgroups of low- or high-risk women, who delivered within six hours or between six and 24 hours after LAT. METHODS: The data charts of all women who delivered at Hammerfest Hospital in 1996, 1997 and 1998 were retrospectively read. If the woman was admitted to the hospital because of onset of labor, was in the first stage of labor and delivered within 24 hours after admission, she was included. In the study period, 1639 gave birth and 932 were included in the study. A descriptive analysis of the population and assessment of LAT's sensitivity, positive predictive value, specificity and negative predictive value at different cut-off values was done. RESULTS: In the study population 5.8% had fetal distress, and 5.3% had an operative delivery because of fetal distress. LAT's sensitivity in the whole population was 0.15 and positive predictive value was 0.16. Specificity was 0.95 and positive predictive value was 0.95. In the subgroups of low- and high-risk women, who delivered within six hours or between six and 24 hours after LAT, sensitivity varied between 0 and 0.36, and positive predictive value varied between 0 and 0.27. Specificity varied between 0.92 and 0.96, and negative predictive value varied between 0.89 and 0.97. CONCLUSIONS: According to these results, LAT cannot be recommended as a screening test for fetal distress in labor in low-risk women. Sensitivity is too low, and there are too many false-positive tests. It is unclear if LAT has benefits among high-risk women.

Adult↗

PubMedDate not supplied

Deciding when it's labor: the experience of women who have received antepartum care at home for preterm labor.

OBJECTIVE: To describe how women who had received antepartum care at home for preterm labor managed subsequent episodes of preterm labor symptoms. DESIGN: Grounded theory method. SETTING: 2 Canadian antepartum home care programs. PARTICIPANTS: 12 women who received antepartum care at home for preterm labor that had been diagnosed in hospital prior to 34 weeks gestation. RESULTS: The core psychosocial process was reconciling body knowledge and professional knowledge. Study participants reported knowing something's not right and followed decision guides to seek help. If, when they returned to the hospital to see what's going on, they felt dissonance between what their bodies were telling them (body knowledge) and what their health care providers were telling them (professional knowledge) an overriding tension developed between not wanting to take a risk for the baby versus not wanting to overreact. These women reestablished their baselines of nonthreatening symptoms at a higher level by setting a new normal to avoid the humiliation associated with appearing to overreact. Attempting to ignore recurring symptoms of preterm labor delayed help seeking and caused anxiety. CONCLUSIONS: To avoid delayed help seeking, nursing interventions should be geared to reducing anxiety and validating the experiences of women with recurring preterm labor symptoms.

Adult↗

PubMed1983

[Progress of labor and cardiotocographic parameters in mobilization during labor].

Report about 156 intrapartum ambulations who failed progress of labor. Internal fetal monitoring was used in all patients. Labor progress with cervical dilatation was stated in 92,1% in first stage and in 68,7% in second stage of labor. An average increase of 10 mmHg in baseline tonus and an increase in amplitude and contraction frequency were found. No significant changes in either FHR baseline, variability or floating line were observed during ambulation. The lack of any demonstrable ill effects with ambulation in labor and the improved tolerance to pain and comfort are remarkable. Intrapartum ambulation with internal fetal monitoring has a great efficacy for progress of labor and is safe for both mother and fetus.

Female↗

PubMed1981

[Prostaglandins in human pregnancy and labor--studies on the levels of PGF2 alpha metabolites and in vitro production of PGE and PGF by uterus and placenta during human pregnancy and labor (author's transl)].

In order to study the relationship between labor and prostaglandin (PG) production, 13,14-dihydro 15-keto-prostaglandin F2 alpha (dhk-PGF2 alpha) in plasma and amniotic fluid and 5 alpha, 7 alpha-dihydroxy 11-keto tetranor-prostane 1,16-dioic acid (the main urinary metabolite of PGF2 alpha [PGF2 alpha MUM]) in urine were measured by radioimmunoassay in 26 patients during pregnancy, labor and puerperium. In vitro PG production was investigated in the myometrium, decidua and amnion, obtained at term from 17 patients (9 before and 8 in labor) in cesarean section and from 7 in vaginal delivery. The radioimmunoassay newly developed for dhk-PGF2 alpha was satisfactory in its accuracy, precision, and sensitivity. During pregnancy, no increase in plasma dhk-PGF2 alpha (ng/ml) and PGF2 alpha MUM excretion (microgram/hour) was detected as delivery approached. But they elevated significantly around parturition (p less than 0.005), and decreased subsequently. A significant elevation of dhk-PGF2 alpha was found in amniotic fluid at delivery (p less than 0.01). PGE production was constant regardless of uterine contraction in three tissues tested, with the amnion showing the highest activity (p less than 0.005). PGF production increased remarkedly in association with uterine contraction in the myometrium and decidua. The myometrium showed the highest activity to produce PGF among three tissues during labor (p less than 0.025). These results indicate that the production of PGF2 alpha is remarkably increased during labor, and the myometrium appears to be the main source of PGF2 alpha.

Amniotic Fluid↗

PubMed1997

The labor-adjusted cesarean section rate--a more informative method than the cesarean section "rate" for assessing a practitioner's labor and delivery skills.

OBJECTIVE: Our purpose was to determine the benefits of an acuity-adjusted labor management tool. STUDY DESIGN: A retrospective review was performed of all deliveries at Good Samaritan Regional Medical Center in Phoenix, Arizona, for a 1-year period from Jan. 1 to Dec. 31, 1994. All physicians with > or = 20 deliveries were included in the analysis. Patients with indications for which most practitioners would perform a cesarean delivery were removed from consideration. Physicians were then compared with respect to labor management in the remaining patients without relative contraindications to vaginal delivery. RESULTS: The total number of deliveries (n = 6062) was performed by 47 attending obstetricians, 9 perinatologists, an obstetrics-gynecology clinic, and a family practice clinic. The "raw" cesarean section rate was 20.1%. Those at high risk for cesarean delivery (n = 534) were excluded, leaving 684 cesarean sections performed in 5528 patients (12.4%) who were appropriate to labor. Differences were observed between the nulliparous cesarean section rate (16%) compared with that for parous patients (10.1%) (p < 0.0001 by Fisher's exact test (two-tailed) but not between attending obstetrician-gynecologists (12.4%) and perinatologists (13.8%) (not significant). CONCLUSION: A labor-adjusted cesarean section rate is more appropriate than just "raw" data. Medical, obstetric, and fetal factors affect a "raw" rate that is out of the control of the obstetrician. This method of assessing the labor and delivery skills of each practitioner and hospital would allow meaningful comparison with others.

Arizona↗

PubMed1991

Labor condition applications and requirements for employers using aliens on H-1B visas in specialty occupations--Department of Labor. Interinal final rule; request for comments.

The Employment and Training Administration (ETA) and the Employment Standards Administration (ESA) of the Department of Labor (DOL or Department) are promulgating regulations governing the filing and enforcement of labor condition applications filed by employers seeking to use aliens in specialty occupations on H-1B visas. Under the Immigration and Nationality Act (INA), as amended by the Immigration Act of 1990 (Act), an employer seeking to employ an alien in a specialty occupation on an H-1B visa is required to file a labor condition application with, and receive the approval of, DOL before the Immigration and Naturalization Service (INS) may approve an H-1B visa petition. The labor condition application process will be administered by ETA; complaints and investigations regarding labor condition applications will be the responsibility of ESA.

Documentation↗

PubMed2000

Continuous electronic heart rate monitoring for fetal assessment during labor.

BACKGROUND: Electronic fetal monitoring (EFM) has been widely adopted. There is debate about its overall effectiveness as well as the relative merits of routine application versus use for high-risk pregnancies only. OBJECTIVES: The objective of this review was to assess the effects of routine continuous electronic fetal monitoring during labour compared with intermittent auscultation. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register, Medline (1966 to 1994), and reference list of relevant articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised trials comparing routine continuous electronic fetal monitoring with intermittent auscultation. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer, and their accuracy was confirmed independently by a second person. A single reviewer assessed study quality based on criteria developed by others for randomised controlled trials. Data reported from similar studies were used to calculate a combined risk estimate for each of eight outcomes. MAIN RESULTS: Nine studies involving 18,561 women and their 18,695 infants were included. The trials were of variable quality. A statistically significant decrease was associated with routine continuous EFM for neonatal seizures (relative risk (RR) = 0. 51, confidence interval (CI) = 0.32,0.82). The protective effect for neonatal seizures was only evident in studies with high-quality scores. No significant differences were observed in 1-minute Apgar scores below 4, 1-minute Apgar scores below 7, rate of admissions to neonatal intensive care units, and perinatal death. An increase associated with the use of EFM was observed in the rate of cesarean delivery (RR = 1.41, CI = 1.23,1.61) and operative vaginal delivery (RR = 1.20, CI = 1.11,1.30). REVIEWER'S CONCLUSIONS: The only clinically significant benefit from the use of routine continuous EFM was in the reduction of neonatal seizures. In view of the increase in cesarean and operative vaginal deliveries, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use continuous EFM or intermittent auscultation during labor.

Cardiotocography↗

PubMed1989

Infection and labor. IV. Cachectin-tumor necrosis factor in the amniotic fluid of women with intraamniotic infection and preterm labor.

A growing body of evidence supports a causal link between subclinical intrauterine infection and preterm labor. The mechanisms responsible for the onset of parturition in this setting have not been elucidated. The conventional view has been that bacterial products increase prostaglandin biosynthesis by intrauterine tissues and this, in turn, leads to the onset of labor. An alternative or complementary mechanism is that microbial products activate the host monocyte-macrophage system and that cytokines released during this process signal the initiation of parturition by stimulating prostaglandin biosynthesis by intrauterine tissues. This study was conducted to determine if cachectin-tumor necrosis factor is present in the amniotic fluid of women with intraamniotic infection and whether this cytokine can alter the rate of prostaglandin biosynthesis by intrauterine tissues. Amniotic fluid from 54 women was assayed for tumor necrosis factor. Tumor necrosis factor was not detectable in the amniotic fluid of women without intraamniotic infection regardless of the presence or absence of term or preterm labor. On the other hand, the amniotic fluid of 11 of 15 women with preterm labor and intraamniotic infection had measurable tumor necrosis factor. This cytokine stimulated prostaglandin E2 biosynthesis by amnion cells in monolayer culture in a dose-dependent fashion. These data support the concept that macrophage activation is involved in the onset of human parturition in the setting of infection. We propose that the host (fetus and/or mother) signals the onset of parturition through the secretion of inflammatory cytokines released in response to bacterial invasion.

Amnion↗

PubMed2005

A review of the role of proinflammatory cytokines in labor and noninfectious preterm labor.

The prevention of preterm labor has the potential to reduce newborn morbidity and mortality by decreasing the incidence of preterm birth. Half of all preterm births occur in women with no known clinical risk factors. Labor onset and progress is multifactorial, and we are just beginning to understand the role of cytokines in uterine activity. The purpose of this article is to review the role of cytokines in labor and preterm labor not associated with infection and to provide implications for research and practice.

Cytokines↗