Book excerpt: The Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia. (Media Reviews).

by Penny Simkin & Ruth Ancheta, Blackwell Science Ltd., 2000, Available through the ALACE bookstore

Editor's Note: This is a brief excerpt from Simkin and Ancheta's book, which provides comprehensive information about causes and treatments of dystocia.

The Phases of the Second Stage

The second stage of labor can be divided into phases (the latent phase and the active phase), just as the first stage is. Each phase represents different behaviors of the woman, and different physiological accomplishments.

The Latent Phase of the Second Stage

A lull in uterine activity around the time of complete dilation is frequently observed and is sometimes referred to as the "latent phase of the second stage," the "resting phase," or the "rest and be thankful phase."

Although a latent phase in the second stage is often perceived as abnormal and may be treated as uterine inertia, it is probably a physiological phenomenon relating to the retraction of the cervix around the head and the descent of the fetal head into the vaginal canal.

This hypothesis is consistent with ... the numerous observational studies of maternal spontaneous bearing-down efforts.

Asking Women to Push during the Latent Phase of the Second Stage

With no interventions at all, the contractions usually resume within 5-30 minutes. During the latent phase, the woman gets some rest, her spirits rise, and she begins to look forward to delivering her child.

In North America, caregivers sometimes misinterpret the latent phase to mean labor has slowed down, and make efforts to speed the second stage.

These unnecessary interventions are less likely to be used when the British approach is used. "In uncomplicated labour, the timing of the decision to encourage maternal effort is usually when the presenting part is `on view' or there is obvious descent of the presenting part with an uncontrollable urge to push."