I am happy to see the responses to my 'nap' scenario, the CNM's here use
sleep  when possible in their hospital setting, though adding epidurals to
the equation is cheating, or Staydol induced naps....I'm talking natural
spacing and labour functions, like any muscle, the uterus can get tired,
and may need to re-energize. Sue

----------
> From: Bonitta Steuer <[log in to unmask]>
> To: [log in to unmask]
> Subject: Re: second stage and pushing
> Date: Monday, September 27, 1999 8:14 AM
> 
> Hello all,
> 
> I've been procrastinating with my introduction, so here it is as well as
> some additional info. re. second stage.
> 
> I'm Bonny Steuer, CNM a Clinical Assistant Professor in the Boston
> University School of Public Health, Nurse-Midwifery Education Program.
> Having just finished my first year on faculty, sometimes overwhelmed with
> all it entails, I have yet to spread my wings in terms of my own
research,
> but am very interested in all the possibilities this group represents. 
> 
> I've been reading with interest the second stage discussion and would
> encourage those interested to also review the work/articles from Joyce
> Roberts:
> 
> Roberts J, Woolley D(1996)A second look at the second stage of labor.
JOGNN
> Vol. 25(5):415-423.
> 
> Aderhold KJ, Roberts JE (1991)Phases of second stage labor:Four
descriptive
> case studies. JNM 36(5):267275.
> 
> Roberts JE et aL (1987) A descriptive analysis of involuntarty bearing
down
> efforts during the expulsive phase of labor. JOGNN 16:48-55.
> 
> Roberts JE et al (1988) Supportive versus directive care in second stage
> labor. DHHS, NIH, NCNR Research Grant 5R01NR01500-02, Univ. of Colorado;
> 57-8, 64.
> 
> Hope this is of help.  Also to respond to the midwife who doubts you
could
> let a woman nap in hospital, while awaiting the urge to push. It does
> happen at the hospital where I practice, I'm happy to say, especially
with
> epidurals. A large inner-city public hospital with a medical staff
> supportive to midwifery philosophy. The midwives will soon be the
> supervisor/teacher for the intern MDs as well!
> 
> Bonny Steuer, CNM
>   At 12:28 PM 9/25/99 -0700, you wrote:
> >this will scew the results: a friend of mine took a two hour nap, after
> >reaching complete, then pushed the baby out in a short time.  OOH
situation
> >of course, this could hardly happen in a hospital.  I've had ladies
reach 6
> >cms, in a slow first stage, nap for a couple of hours, go to 10 cms in a
> >short time, then push the baby out.  Anyone doing a study on 'naps' for
> >maternal exhaustion?  Sue
> >
> >----------
> >From: Andy & Louise <[log in to unmask]>
> >To: [log in to unmask]
> >Subject: second stage and pushing
> >Date: Wednesday, September 22, 1999 1:06 PM
> >
> >Dear All
> >
> >There is a school of thought that second stage of labour should be
> >redefined to include the decent of the presenting part (when the vertex
is
> >visible it is second stage).  If a woman's cervix is fully dilated but
the
> >head is at the spines she won't get that urge to push (Fergusson reflex)
> >therefore should we as midwives be directing her to push!  The issue of
how
> >long do you give at full dilatation should surely depend on the well
being
> >of the woman and the baby, if the FH is ok and the woman is coping well
> >with labour why not await events.  In my experience (be it limited as I
am
> >a 3rd year student)  waiting for the woman's body to define second stage
> >results in much more fulfilling outcome for mother and baby.  A lot of
> >women who are forced to push before their bodies are ready or before the
> >baby is in the right position become exhausted too quickly and very
often
> >need an assisted delivery. Another important aspect of this discussion
> >should include the position of the woman during her labour, we all know
> >that an upright posture aids descent which in turn aids progress in the
> >second stage.
> >
> >I hope my contribution to the discussion is of value as I really enjoy
the
> >list and I have learnt a lot of valuable information from it.
> >
> >love Louise Walker
> >
> >
> >
> 


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