Cover -- Half-title -- Title -- Copyright -- Dedication -- Contents -- Acknowledgments -- Web-Forum -- 1 General introduction -- 1.1 Purpose -- 1.2 Target readership -- 1.3 Presentation -- Section 1: A wake-up call -- Section 2: Back to basics -- Section 3: Proactive support of labor -- 1.4 Evidence grading -- 1.5 Advice for readers -- 1.6 Classification of birth professionals -- REFERENCES -- Section 1: A wake-up call -- 2 Medical excess in normal childbirth -- 2.1 The cesarean pandemic -- 2.1.1 Operative solutions for failed labors -- 2.2 Instrumental delivery rates -- 2.3 Conceptual flaws -- 2.3.1 Professional controversies -- 2.4 Counting the costs -- 2.4.1 Psychological harm -- 2.4.2 Direct physical harm -- 2.4.3 Medical harm to subsequent pregnancies -- 2.4.4 Increased neonatal mortality -- 2.4.5 Neonatal and long-term pediatric morbidity -- 2.4.6 Economic damage -- 2.4.7 Prejudice of future reproduction -- 2.4.8 Social damage -- 2.4.9 Dangerous export -- 2.4.10 Declining overall quality of childbirth -- 2.5 Summary -- REFERENCES -- 3 Iatrogenic causes of failed labors -- 3.1 Dynamic labor disorders -- 3.1.1 Symptom-based interventions -- 3.1.2 Lack of definitions -- 3.2 Lack of an overall plan -- 3.2.1 Non-management of first-stage labor -- 3.2.2 Lack of professional interest -- 3.2.3 Discontinuous care -- 3.2.4 The expectant approach -- 3.2.5 The interventional approach -- 3.2.6 The paradox -- 3.3 Mechanics-oriented view of childbirth -- 3.3.1 The mechanistic paradox -- 3.4 Summary -- REFERENCES -- 4 Harmful birth care practices -- 4.1 Idle faith in technology -- 4.1.1 The cesarean boomerang -- 4.1.2 Technical excess and harmful rituals -- 4.2 Negative psychology -- 4.2.1 Discouraging stories -- 4.2.2 The culture of fear -- 4.2.3 Professional daunting -- 4.3 Clinical ambiance -- 4.3.1 Women's sense of isolation.

4.3.2 Frustratingly casual attitudes -- 4.3.3 Divided attention -- 4.4 Care of fetus versus care of mother -- 4.4.1 Fetal trauma -- 4.4.2 Parallel interests -- 4.5 Summary -- REFERENCES -- 5 Destructive territorial disputes -- 5.1 Controversial birth philosophies -- 5.1.1 Adverse working relations -- 5.2 Cross-cultural differences -- 5.2.1 Disputes in medicalized countries -- 5.2.2 Disputes in midwife-centered systems -- 5.3 Myths and facts of autonomous midwifery -- 5.3.1 Autonomous gate-keepers -- 5.3.2 Transfer rates -- 5.3.3 Discontinuous and unsafe care -- 5.4 Universality of childbirth -- 5.4.1 In search of the evidence -- 5.4.2 Bridging the controversies -- 5.5 Summary -- REFERENCES -- 6 Self-sustaining mechanisms -- 6.1 The applause phenomenon -- 6.2 Patient consumerism -- 6.2.1 Biased patient information -- 6.3 Liability concerns and control -- 6.3.1 Defeatism -- 6.3.2 Convenience -- 6.3.3 False information -- 6.3.4 Remuneration practices -- 6.3.5 Inflation -- 6.4 Ignoring the evidence -- 6.4.1 Invalid excuses -- 6.4.2 Resistance to change -- 6.5 Educational flaws -- 6.5.1 Deficient training in labor and delivery skills -- 6.5.2 Post-doctoral education and development -- 6.6 Evidence-based versus concept-based care -- 6.7 Summary -- REFERENCES -- Section 2: Back to basics -- 7 Lessons from nature -- 7.1 Comparative biology -- 7.1.1 Duration of natural birth -- 7.2 The biological functions of labor pain -- 7.2.1 Warning sign -- 7.2.2 The role of endorphins -- 7.3 Psychovegetative regulation -- 7.3.1 The parasympathetic system -- 7.3.2 Biological effects of stress -- 7.4 Summary -- REFERENCES -- 8 Elementary biophysics of birth -- 8.1 The prelabor preparation of the uterus -- 8.1.1 The fetal trigger -- 8.1.2 Biochemistry -- 8.1.3 Functional transformation at two distinct levels -- 8.2 Prelabor transformation of the cervix.

8.2.1 Cervical ripening -- 8.3 The prelabor transformation of the myometrium -- 8.3.1 Braxton Hicks contractions -- 8.3.2 The activation of the myometrium -- 8.4 The onset of labor -- 8.4.1 Electromechanical coupling -- 8.5 The physics of effective labor -- 8.5.1 Uterine coordination -- 8.5.2 Uterine force -- 8.5.3 Cervical resistance -- 8.5.4 A clinical measure for effective labor -- 8.6 Exhaustion of the uterus -- 8.7 First labor compared with subsequent labors -- 8.7.1 The fundamental parity difference -- 8.8 Fetal oxygenation during labor -- 8.8.1 The placental reserve capacity -- 8.8.2 Interval uterine relaxation -- 8.8.3 Disorganized uterine action and fetal distress -- 8.9 Important clinical implications -- 8.9.1 Induction of labor -- 8.9.2 Augmentation of labor -- 8.9.3 Only progress counts -- 8.10 Summary -- REFERENCES -- 9 First-stage labor revisited -- 9.1 Normal pattern of dilatation -- 9.1.1 The Friedman doctrine defeated -- 9.1.2 Fundamental reassessment -- 9.1.3 The fallacy of the latent phase -- 9.1.4 Defining the beginning of labor -- 9.1.5 Duration of normal labor -- 9.1.6 No deceleration phase -- 9.2 Dynamics and mechanics of first-stage labor -- 9.2.1 Wedging action through descent -- 9.2.2 Retraction phase and wedging (descent) phase of first-stage labor -- 9.2.3 Relationship between dilatation and descent -- 9.2.4 Fetal adaptations to negotiate the birth canal -- 9.3 Natural threshold between first- and second-stage labor -- 9.3.1 Misleading and obsolete definition -- 9.3.2 Natural demarcation point -- 9.3.3 Clinical implications -- 9.3.4 The evidence -- 9.5 Summary -- REFERENCES -- 10 Second-stage labor redefined -- 10.1 Passage through the osseous and soft parts of the birth canal -- 10.1.1 Pelvic adequacy -- 10.1.2 Internal rotation and extension -- 10.2 Misconceptions.

10.3 Expulsive force versus pelvic soft-tissue resistance -- 10.3.1 Maternal position -- 10.4 Summary -- REFERENCES -- 11 Definitions and verbal precision -- 11.1 Elementary parameters of parturition -- 11.1.1 Labor pains = contractions of labor -- 11.1.2 Effacement -- 11.1.3 Cervical accessibility versus dilatation -- 11.1.4 Dilatation -- 11.1.5 The transition at full effacement -- 11.1.6 The beginning of labor -- 11.1.7 Crucial clarity -- 11.1.8 "Good" contractions -- 11.1.9 Pitfall of intrauterine pressure readings -- 11.2 Redefining the stages and phases of labor -- 11.2.1 The latent phase refuted -- 11.2.2 Normal progress in dilatation -- 11.2.3 Onset of second-stage labor -- 11.3 The concept of normal labor -- 11.4 Summary -- REFERENCES -- Section 3: Proactive support of labor -- 12 Introductory synopsis -- 12.1 The origin -- 12.1.1 Conceptual birth care -- 12.1.2 Misunderstandings and controversy -- 12.1.3 Distortion, perversion, confusion -- 12.1.4 Need for a new name -- 12.2 Proactive support of labor -- 12.2.1 Justification and rehabilitation -- 12.3 The leading principle -- 12.4 Features and benchmarks -- 12.4.1 Purpose and target group -- 12.4.2 An overall plan -- 12.4.3 Unequivocal information -- 12.4.4 Natural scientific basis -- 12.4.5 Focus on first labors -- 12.4.6 A clear diagnosis of the onset of labor -- 12.4.7 Early detection and correction of dysfunctional labor -- 12.4.8 A twelve-hour limit -- 12.4.9 Personal attention and continuous support -- 12.4.10 Coaching -- 12.4.11 Prelabor preparation and assurance -- 12.4.12 Coping with labor pain -- 12.4.13 An end to elective inductions -- 12.4.14 Safety for mother and child -- 12.4.15 Appropriate working relations -- 12.4.16 Organization -- 12.4.17 Quality control and audit -- 12.4.18 Evidence-based obstetrics -- REFERENCES -- 13 Nulliparous versus parous labor.

13.1 Unique first experience -- 13.2 Parity-specific features -- 13.2.1 Duration of labor -- 13.2.2 Nulliparous dynamics versus multiparous mechanics -- 13.2.3 Fetal distress -- 13.2.4 Trauma -- 13.2.5 Rupture of uterus -- 13.2.6 Specification of the meaning of multiparity -- 13.3 Parity-based approaches -- 13.3.1 Prolonged labor in nulliparas: a dynamic disorder -- 13.3.2 Protracted labor in multiparas: a mechanical problem -- 13.3.3 Correct mindset -- 13.4 Summary -- REFERENCES -- 14 Diagnosis of labor -- 14.1 Professional responsibility -- 14.1.1 A firm clinical decision -- 14.2 Objective symptoms -- 14.2.1 Pains -- 14.2.2 Effacement and dilatation -- 14.2.3 Bloody show -- 14.2.4 Immediate progress -- 14.2.5 Ruptured membranes -- 14.3 The objective diagnosis of labor -- 14.3.1 Prelabor education and instructions -- 14.3.2 Documentation -- 14.4 Indecision -- 14.4.1 The concept of the latent phase discarded -- 14.4.2 Avoided diagnosis -- 14.5 Errors in diagnosis -- 14.5.1 False-negative diagnosis -- 14.5.2 False-positive diagnosis -- 14.6 False start -- 14.6.1 Factors contributing to a false start -- 14.6.2 Management of a false start -- 14.6.3 Sedation versus pain relief -- 14.6.4 Preventing a false start -- 14.7 Proactive support of labor -- 14.8 Summary -- REFERENCES -- 15 Prevention of long labor -- 15.1 Duration of normal labor -- 15.1.1 Statistics -- 15.1.2 Impact of prolonged labor -- 15.1.3 Prospective norm for normal progress -- 15.2 The partogram -- 15.2.1 A prospective and simple, visual record -- 15.2.2 Features of a useful partogram design -- 15.3 Monitoring progress -- 15.3.1 Early assessments -- 15.4 Patient information and guidance -- 15.4.1 Prediction of the hour of birth -- 15.4.2 Crucial bedside clarity -- 15.5 Timely correction -- 15.5.1 Selective but timely use of amniotomy and oxytocin -- 15.5.2 Advantages to the mothers.

15.5.3 Misguidance from poor studies.