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These causes reflect both passenger and passage and can significantly affect labour progress and outcome. For the pelvis shape it often requires a caesarean section to birth safely and for the LGA baby it may be the same or if birthed vaginally may have a larger risk of tearing or shoulder dystocia. Midwives can position the woman to put less pressure on the perineum and have warm compresses. Otherwise similar to above, manoeuvres can be used to aid in shoulder dystocia if present. 

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ensuring the environment is as least 'clinical' looking and sounding by utilising dimmed lighting with fairy lights, the use of aromatherapy to surround yourself with calming pleasant smells, music of your choice, etc are all ways to get that oxytocin flowing and stimulate powerful uterine contractions. Ensuring a good mind set with positive affirmations are ways to allow your body to work with the contractions instead of fighting against them. Providing reassurance to women is a way to empower them to work with their body and the power of the contractions.

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1. Offer non-pharmacological pain relief such as heat packs, warm water immersion (bath and/or shower), massage, TENS machine, calming music, essential oils, keeping hydrated, birth ball varying positions, utilisiation of other equipment such as gym mat, sterile water injections.
Offer pharmacological pain relief options if preferred, such as inhalation analgesia, IM injection, epidural.
2. Building rapport with the woman early, discussion and review of birth preferences early and review as required, use open communication and check woman's understanding, address any concerns from the woman promptly, ensure a calm environment and ask the woman to disclose strategies used (if appropriate) to stay calm eg. favourite music, utilise room speakers if desired, essential oils (oils and burners available in some birth facilities), meditation, breath work, having a support person/s present, ensuring hydration, regular bladder emptying, managing pain relief and physical comfort measures as above. 

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Reassurance that labour is normal and to go with the urges in her body. Try not fight the contractions. Involve support people and make her feel comfortable. Using dimmed lights, small or brief interaction if needed. Familiar music or scents, aromatherapy. Making the room private and her own space 

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Contractions should be regular and effective to rotate and descend the fetus into the pelvis effectively. When they aren't it can cause malpresentation It is important to regularly palpate contractions to determine strength, length, duration and resting tone over a 10 minute period. Encouraging women into upright positioning to help optimal fetal descent and reinforce the contractions. Depending on the individual circumstance the Midwife may need to get order from the DR for Syntocinon to establish effective regular contractions.

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1. encourage side lying, throne position, peanut balls between legs to open pelvis, on hands and knees on bed if able to which can all assist to help with fetal decent and alignment. If no epidural encourage upright positions such as walking, swaying, exercise balls and squatting.

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1. Having an epidural/not mobilising in labour 

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Assess the fetal position by firstly gaining consent to perform an abdominal palpation followed by a VE if necessary. For a shoulder dystocia call for help once identified and follow protocol for shoulder dystocia maneuvers. Ensure fetal position is known, commence with McRoberts and fundal pressure. 

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This aspect refers to supporting the pregnant client’s psychological adaptation to labour.

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Position refers to the maternal position during labour and birth.

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This refers to the contraction of the uterus and the maternal effort that moves the fetus  out of the uterus.

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The passageway includes the bony pelvis, the soft structures of the cervix, the vagina, and the introitus. 

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Passenger refers to the position of the fetus.