At last, a book that offers practical advice for nurses and midwives who wish to help to prevent and treat dysfunctional labor! Penny

Simkin and Ruth Ancheta have done a superb job of interweaving the clinical wisdom of observant, expert practitioners with the best

available research evidence about what helps and does not help women during labor.

I wish this book had been available a long time ago. In the early 1970s when I was a novice labor and delivery nurse, I observed a

common but puzzling problem. In those days we subjected women to an admission routine that included a variety of very unpleasant

procedures. (Thankfully the worst of these procedures perineal shaves, enemas, and rectal exams have since been recognized as

useless or harmful and have been eliminated from common practice.) Part of the admission routine involved assessment of the quality

and strength of contractions. When I inquired about the contractions, I was often told, 'My contractions were frequent and strong at

home, but they seem to have gotten a lot weaker and further apart since I arrived.'

I would reply, 'Do not worry, this happens a lot. After we finish the admission procedures and you are settled in here, your labor will

probably get going again.'

Why did I say this? I believed it. I had observed it often and had overheard experienced colleagues reassure their patients in this way.

At some intuitive level I felt the decrease in labor intensity was caused by the woman's reaction to the stress of the hospital admission

routine. But at the time almost nothing had been written about the role of stress hormones on uterine function, nor about the

relationships between maternal anxiety, environmental influences, stress hormones, and labor complications. And the randomized

controlled trials showing the substantial benefits of labor support had not even been conducted yet1.

What about the instances in which labor did not return