Western childbirth practices have changed substantially over the last century. Although many advances have been made in the last half-century to improve obstetric care, there is still far to go to enhance our understanding of the process and to optimize outcomes. Their physiology and mechanics are so complex it is remarkable that in most cases they occur smoothly and without maternal or fetal adversity. Human labor and birth, extraordinary events refined by evolution to have ably sustained our species over 200 millennia, are delicately programmed and awe-inspiring. Conscientiously implemented, the approach to the evaluation of labor outlined in this review will result in a reasonable cesarean rate and minimize risks that may accrue from the labor and delivery process. Normal labor and delivery pose little risk to a healthy fetus but dysfunctional labors, especially if stimulated excessively by oxytocin or terminated by complex operative vaginal delivery, have the potential for considerable harm. This requires there be a documented labor dysfunction or a legitimate medical reason to shorten the labor. Oxytocin treatment should be restricted to situations in which its potential benefits clearly outweigh its risks. It has a high therapeutic index, but is easily misused. These observations must be integrated with information derived from the labor curves. Clinical cephalopelvimetry involves assessing pelvic traits and predicting their effects on labor. Several factors are strongly associated with development of labor disorders, including cephalopelvic disproportion, excess analgesia, fetal malpositions, intrauterine infection, and maternal obesity. Many may be related to insufficient or disordered contractile mechanisms. Based on these curves we recognize nine discrete labor abnormalities. Graphing of serial measurements of cervical dilatation and fetal station creates “labor curves,” which provide diagnostic and prognostic information. We describe a coordinated approach to the assessment of labor. These assessments require skillful physical diagnosis and the ability to translate the acquired information into meaningful prognostic decision-making. During labor mother and fetus are evaluated at intervals to assess their well-being and determine how the labor is progressing.
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