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CLINICAL ISSUES

A New Understanding of the Second Stage

of Labor: Implications for Nursing Care
Joyce E. Roberts

A reconceptualization of the second stage of

labor is proposed, with an early phase of descent and
a later phase of active pushing, as the basis for nursing care related to direction or support of expectant
mothers bearing-down efforts. This reconceptualization challenges the rules that have accompanied second stage by providing criteria for the obstetric conditions optimal for fetal descent that develop during
the initial phase of second stage as the fetal head
rotates to an anterior position and descends to at least
a 1+ station. The phase of active pushing is accompanied by a decline in fetal pH and should be shortened, not only by assisting the woman with effective
bearing-down but also by allowing a longer early
phase of second stage and encouraging the woman to
push only when the obstetric conditions are optimal.
JOGNN, 32, 794801; 2003. DOI: 10.1177/
0884217503258497
Keywords: Labor and birthLaboring down
Labor supportPhysiologySecond stage
Accepted: May 2003
The second stage of labor is a profound experience for expectant mothers and a period of intense,
continuous care by a nurse or other qualified person.
It is assumed that the registered nurse is responsible
for the care needed and given during this critical
stage of labor and either provides it herself or oversees and influences the support or assistance given
by another person, such as a doula, the father of the
child, or other companion. For the woman, the force
and the sensations of the uterine contractions that
are eventually accompanied by a strong urge to bear
down are overwhelming. The desired birth is now
imminent and the effort often required to accom794 JOGNN

plish delivery challenges women physically and psychologically. The second stage of labor is also a challenge for the nurse. This article reviews these challenges for the nurse and identifies principles to help
guide this care.
The challenges for the nurse begin with assessment of labor progress based on cervical dilation,
fetal rotation, and descent; decision making about
the timing of instructions or direction to the expectant mother to push; and consideration of how to
most effectively help her with bearing-down, what
positions might be helpful, and which companion at
her birth may be most able to help. The nurse also
must identify any factorsemotional or physical
that may be interfering with progress; she will need
to assess how the woman is coping with the pain,
pressure sensations, or concerns about her progress,
her safety, and her ability to achieve this feat of
childbirth. Other challenges the nurse must incorporate into care of the woman are assessment of the
ongoing features of uterine contractions, fetal heart
rate (FHR) patterns, bladder status, and maternal
vital signs; ongoing documentation of maternal and
fetal status, labor progress, and accompanying
events; and maintenance of appropriate and timely
communication with the birth attendant, nursery
staff, or other caregivers. The nurse also needs to
ensure that the necessary equipment and supplies are
available and, when needed, ready for the birth. This
is, indeed, a period of intensive care that in the contemporary perinatal unit is accompanied by much of
the technology of a specialized care unit.
The equipment that may accompany the care of a
woman in advanced labor has increased in number
and complexity (Kozak & Weeks, 2002). Despite the
lack of scientific evidence for continuous electronic
Volume 32, Number 6

fetal monitoring (EFM) for women who are essentially

healthy and at low risk obstetrically (Haggerty, 1999), the
use of a fetal/uterine monitor often accompanies this
phase of labor. This is due to the increased concern about
fetal tolerance of labor and the practical advantages that
the continuous recording of uterine contractions and
FHR contributes to care at this time. The uterine contraction tracing may facilitate the recognition of contractions
for the woman with epidural analgesia, and the increased
variation in FHR patterns can be more accurately
assessed in conjunction with the dual recording of uterine
activity and the FHR.
For women with at-risk pregnancies, dysfunctional
labor, or fetuses with nonreassuring FHR patterns, the use
of continuous EFM is indicated. The use of internal/direct
fetal and/or uterine devices may also make it easier for the
woman to reposition herself without disrupting the placement of the external belts for the tocodynamometer and
ultrasound transducer. However, the use of the fetal oxygen saturation sensor may limit the womans mobility and
add another item of technological equipment to the labor
area. In addition, the frequent use of oxytocin and intravenous infusion of fluid (Curtin, 1999; Curtin & Mathews, 2000) will add an intravenous line and infusion
pump to the equipment at the bedside. The increased use
of epidural analgesia also involves additional equipment,
the anesthesia cart, often a pulse oximeter for the mother,
and an automated blood pressure cuff. Thus, the nurse
needs to coordinate care of the woman while attending to
the functional status of the equipment and the information it may be periodically providing. She or he needs to
be adept in managing the technology, which may even
involve computer-based charting, and have the interpersonal skills of compassion and effective support that can
augment a womans capability to cope with second-stage
labor. In addition, the nurse will have involved the
woman in active decision making about how to manage
her labor and her preferred strategies for pain relief, for
companionship, and for the birth itself. This decision
making is an ongoing process as the woman copes with
labor, as she progresses in dilation or not, and as her condition and that of her fetus are assessed and needs are
addressed.
The intense nature of the care involved in advanced
labor contributes to the establishment of routines and
rules that minimize the stress of decision making. Some
rules, however, can interfere with appropriate care when
they are used in an arbitrary fashion. Such rules include
no pushing before complete dilatation; one must
begin pushing at complete dilatation (10 cm) or the baby
will not come down; and pushing for as long and hard
as one canto the count of 10 and three times with a
contraction. Over the past 20 years, researchers have
challenged these rules, based on descriptive analyses of
the pattern of second-stage bearing down efforts (BDEs)
November/December 2003

and experimental studies comparing maternal positions

and approaches to assisting women with their BDEs
(Roberts, 2002).
More upright positions have been shown to have the
advantages of less pain and lower incidence of abnormal
FHR patterns. Less strenuous BDEs that rely primarily on
the womans involuntary pushing urge and are delayed
until advanced descent of the fetal head have been accompanied by less maternal fatigue (Hansen, Clark, & Foster,
2002), perineal injury (Fraser et al., 2000; Sampselle &
Hines, 1999), fetal acidosis (Roberts, 2002; Thomson,
1993), and need for instrument-assisted delivery (Vause,
Congdon, & Thornton, 1998).
In addition to this evidence about specific second-stage
care practices, there is also evidence that the second stage
of labor progresses in phases that have different implications for care or instruction to the woman as well as for
fetal outcome (Roberts, 2002). Recognizing these phases
affects whether or not the nurse directs or encourages the
woman to push, and in the extent of pH decline (acidosis)
the fetus develops during this final period of labor.

Reconceptualizing Second Stage

Phases of Second Stage
It is proposed that the second stage of labor be reconceptualized as having phases related to the existence and
quality of a maternal urge to push and to obstetric conditions related to fetal descent. The traditional definition of
second stage is the time from the diagnosis or detection of
complete cervical dilation to the birth and is seen as an
expulsive phase, that is, the portion of labor when the
woman experiences an urge to bear down and to push.
However, an involuntary urge to push may precede the
complete dilation of the cervix or may occur some time
after the recognition of complete cervical dilation. This
variation in the time of the initial urge to push is due to
other obstetric factors that must be favorable for further
fetal descent and birth.
These conditions or features of labor progress are
called the fetal station and position. When the fetal presenting part has advanced past the ischial spines to at
least a +1 station (ideally to the pelvic floor at a +3 or
lower station) and has begun to rotate to the anterior
position, or is anterior (LOA or ROA), the womans
BDEs will be more efficient in achieving further descent
and birth than if she is directed to push based solely on
the dilation of the cervix. Not only will the womans
BDEs be more effective and less fatiguing when they are
accompanied by advanced station and anterior rotation
of the fetal head, but women generally do not feel a
strong urge to push until the fetal head has advanced to
the pelvic floor and Fergusons reflex is evoked from
stretching of the pelvic floor muscles.

JOGNN 795

The occurrence of a strong urge to push characterizes

the later phase of second stage and has been called the
phase of active pushing, the final stage, or the pressperiode (Roemer, Harms, Buess, & Horvath, 1976). The early
phase of second stage has been referred to as the pelvic
phase because it is during this phase that the fetal head is
negotiating the pelvis, rotating and advancing in descent.
Using this anatomical terminology, the later phase is
called the perineal phase because at this phase the fetal
head is lower in the pelvis and is distending the perineum.
This later phase of second stage may be accompanied
by a significant decline in fetal pH along with forceful
maternal BDEs and breath holding (Piquard, Schaefer,
Hsiung, Dellenbach, & Haberey, 1989). The later phase
of labor, with active pushing, is also associated with the
occurrence of muscle and nerve damage that might be
minimized if this phase of labor is shortened and the early
phase prolonged (Handa, Harris, & Ostergard, 1996).
Shortening of the phase of active pushing and lengthening
the early phase of passive descent can be achieved by
delaying encouragement to push until the obstetric conditions are truly optimal. That is, the early portion of the
second stage should be prolonged by not encouraging the
woman to push until she has a strong urge to do so and
the descent and rotation of the fetal head are well
advanced. The later phase of active pushing can be shortened by encouraging the woman to push most effectively
when the conditions are optimal.
Effective pushing can be achieved by assisting the
woman to assume a more upright position or squatting, if
necessary (Shermer & Raines, 1997; Simkin & Ancheta,
2000). Even walking and movement, if the expectant
mother is able, or turning from side to side in a bed, can
facilitate rotation of the fetal head and descent. Leaning
on a birthing ball, now available in some perinatal units,
can ease the intensity of a backache and possibly dislodge
a posterior-positioned fetus.

Duration of Phases
It is not clear from the available research how long the
duration of active pushing should extend. Arbitrary limits on the duration of second stage, such as the 2-hour
rule, have been refuted (American College of Obstetricians and Gynecologists [ACOG], 1994). European investigators who have addressed the duration of rest in the
early phase of second stage when epidural analgesia is
used recommend that this phase be no longer than 1 hour
(Gleeson, & Griffith, 1991; Manyonda, Shaw, & Drife,
1990). However, evidence of the development of fetal acidosis and maternal perineal denervation injury to pelvic
muscles and nerves suggests that forceful pushing for
more than 1 hour is detrimental (Allen, Hosker, Smith, &
Warrell, 1990; Handa et al., 1996). The duration of active
pushing is more relevant to fetal and maternal condition
than the total duration of the second stage.
796 JOGNN

In considering the total duration of second stage, the

probability of a spontaneous birth with epidural analgesia diminishes significantly after 3 hours, especially for
the woman older than 33 years and whose fetus/newborn
weighs more than 3 kg (Kadar, Cruddas, & Campbell,
1986). Thus, the nurse should not be indifferent to the
total length of time for achievement of parameters of
progress (rotation and descent) once complete cervical
dilation is recognized. However, she or he should pay particular attention to the duration of active pushing. Until
the time parameters for the phases of passive descent and
active pushing are more clearly determined, supportive
nursing care should aim to achieve a longer early, pelvic
phase of passive descent, and a shorter perineal phase of
active pushing, by assisting the woman in effective BDEs.
In addition, the nurse should pay close attention to fetal
tolerance of labor and recognize lack of descent so that
any necessary obstetric assistance can be obtained.

An Early Urge to Push

Questions are often asked about situations when
women have an urge to push prior to complete dilation.
It is this circumstance that evokes the no push rule. However, if the obstetric conditions are optimal for descent,
that is, the station is at least +1 and the fetal head is rotating from the OT to OA, and a soft cervical rim retracts
back around the fetal head with a contraction, the woman
can be supported in these BDEs. These early BDEs, which
are usually of small amplitude (as measured on a recorder
and felt by the woman), can be recognized as evidence of
good progress, and the woman can be permitted to push
at the height of a contraction when the urge is the

he hypoxia and acidosis that develop

in the fetus with maternal bearing down
efforts can be minimized by delaying
direction or encouragement to push until
later in the second stage.

strongest. In this early phase of labor, it is not desirable to

promote sustained, strenuous BDEs that will tire the
woman and contribute to a decline in fetal pH, but rather,
to encourage her to continue to breathe slowly and deeply
with contractions; maintain her relaxation until the urge
is irresistible; and then to push just at the height of a contraction, relaxing and breathing slowly again as the contraction eases off.
The approach of not encouraging a woman to push
upon complete cervical dilation or at the occurrence of
Volume 32, Number 6

the initial small urges but allowing her to progress to a

point of a strong, involuntary urge to push is not new. It
was recommended by Grantly Dick-Read (1947) in his
article on the conduct of physiological labor. He
instructed women to continue to relax and use slow, deep
breathing with contractions in early second stage and to
push only at the top of a contraction. Eventually, with
fetal descent, a strong urge to push would develop. It
should be noted that he also advocated breath holding
when a strong urge to push was present. Considering
what is known today about the effects of the Valsalva
maneuver that are evoked by forceful exhalation against
a closed glottis (Roberts, 2002), this strategy is best
reserved for women who need more force to achieve fetal
descent. Encouragement or directions to push more forcefully or more effectively should be offered only in the later
phase of second stage of active pushing, to minimize
hypoxia and acidosis in the fetus.
More recently, a nurse researcher studying supportive
nursing care during labor interviewed a nurse who had
learned that arbitrary rules did not help in supporting
women during the second stage. This nurse had adopted
the strategy of following the mothers body in helping
with second-stage sensations, pain, and pushing. She used
strategies that involved dialogue and diverse actions related to what the mother was feeling and what provided
relief or progress. This nurse stated, I learned that you
can push before 10 cm, and you dont have to push at 10
cm (Sleutel, 2000, p. 40).
The strategy of providing the woman with primarily
supportive care and encouragement in dealing with transitional contractions is appropriate for the early phase of
second stage, as the fetal head descends and the urge to
push develops from, initially, a small sensation only at the
peak of a contraction to a forceful urge as the involuntary

he second stage has an early phase of

passive descent and a later phase of active
pushing that develops with a strong maternal
urge to push when the obstetric conditions are
optimal for further descent and birth.

bearing-down reflex becomes stronger. The later portion

of second stage should be characterized by reinforcement
of effective BDEs or instruction in focusing on pushing in
a way that directs the force down through the abdomen
and not in the upper chest. Some women need instruction
and assistance in finding a position to more effectively
direct their pushing toward the lower pelvis. Others do
November/December 2003

not. Directions should be reserved for those who need

assistance. For many women, only positive reinforcement,
encouragement, and comfort measures are needed to
achieve progress and a timely birth.

Directed Pushing
The adverse effect of directing a woman to push in a
manner that seems effective to the care provider, or based
on the appearance of a contraction on the uterine monitor, is establishment of a pattern of BDEs not in synchrony with the womans own bearing-down urge. This
involuntary urge is evoked when a uterine contraction
achieves an amplitude of at least 30 mm Hg, and as the
fetal head stretches the muscles of the pelvic floor and
evokes Fergusons reflex, which is accompanied by oxytocin release (Roberts, 2002; Roberts, Goldstein, Gruener, Maggio, & Mendez-Bauer, 1987). The additional oxytocin augments the quality of uterine contractions and
facilitates expulsive effort when mothers bear down with
the more forceful contractions.
Therefore, the obstetric conditions optimal for fetal
descent include cervical dilation, fetal station of at least
+1, fetal position approaching OA, an involuntary urge to
push (in the absence of an epidural), and uterine contractions of adequate intensity. When these conditions exist,
the nurse should offer encouragement in accordance with
the womans involuntary urge, relying on the coordination of the contraction with maternal effort, not on the
nurses external assessment of the contraction from the
uterine monitor.

Alterations With an Epidural

For the woman who has an epidural and feels no urge
to push, the nurse can also use the above criteria for
obstetric conditions that favor descent in deciding when
to assist her with bearing down. The nurses strategy is to
assess fetal station and position and recognize when these
are optimal, ideally when the fetal head is visible on the
perineum. At this time, it is appropriate to add the force
of maternal bearing down to the uterine contractions to
achieve birth.
The nurse should then palpate the uterine contractions
and recognize when they are starting and then approaching their peak intensity. As the contraction is beginning,
the woman can be instructed to prepare to push, by taking a cleansing inspiration as the contraction is increasing
and then pushing with the greatest force of the contraction. Women generally take two to four breaths between
BDEs, which enables their blood to become re-oxygenated
as they push a second or third time. The woman will usually relax again between contractions.
The increased use of epidural analgesia, to 70% to
90% in some maternity units (Shermer & Raines, 1997),
combined with evidence of the adverse effects of early,
sustained, strenuous pushing, has contributed to a reassess-

JOGNN 797

ment of the conduct and duration of this stage of labor.

The practice of laboring-down (King, 1997; McCartney,
1998) or rest and descent (Hansen, Clark, & Foster,
2002; Minato, 2000) reflects an unexpressed awareness
of an initial phase of second stagethe pelvic phase
when further fetal descent and rotation need to occur
before the woman experiences an urge to push or can
push effectively. This article more explicitly recognizes the
early phase of second stage and the obstetric conditions
that are necessary for effective BDEs with laboring down.
A related controversy is whether the epidural should be
maintained for pain relief or allowed to wear off so that
the woman will feel an urge to push (Petersen & Besuner,
1997). Although an urge to push is a good indication that
descent and rotation have occurred, it may not be in the
womans best interests to diminish the relief of pain to be
able to note an involuntary urge. The discontinuation of
epidural analgesia is not often included in informed consent, and the sudden return of severe pain may be especially distressing to a woman who has been free of pain.
In one clinical study, the discontinuation of an epidural was associated with an increased rate of forceps use,
rather than a reduction, due to the increased pain and difficulty with pushing that women experienced when they
no longer had the effect of an epidural (Phillips &
Thomas, 1983). In this study, 59 women who had
received extradural analgesia were randomly assigned to
a group whose extradural block was continued through
second-stage labor or another where it was allowed to
wear off. The duration of second stage was the same for
both groups, suggesting that the return of pain, distress,
and increased sympathetic activity and catecholamine levels for the women whose epidurals had worn off impaired
their uterine activity and prolonged the second stage. The
rate of forceps assistance by this group was nearly twice
(12 of 28) the rate of forceps use in women with continued epidural infusion (7 of 28). In addition, twice as
many (5 versus 2) of the indications for forceps were for
fetal distress in the group of women without pain relief,
reflecting the deleterious effect on the fetus of unrelieved
maternal pain and the effect of catecholamines in reducing uterine perfusion.
It is not clear from the current research whether the
strategy of reducing or titrating the infusion rate of a continuous epidural might be a successful alternative to discontinuation of the analgesia. However, it seems inhumane and counter to the intent of an epidural (pain relief)
to withdraw this agent at a time during labor when pain
and pressure are maximal, especially if further labor
progress is impeded and not consistently enhanced. Further research about this practice is needed, but it might be
difficult to obtain an adequate, informed, and willing
sample. Rather than focusing on the occurrence of an
involuntary urge to push, the nurse who is caring for a
woman with an epidural who is allowed to labor down
798 JOGNN

TABLE 1

Principles for Facilitating Second Stage

Descent will not occur until obstetric conditions are optimal.
The occurrence and quality of maternal bearing-down
efforts (BDEs) reflect fetal descent/advancing station.
Prior to complete cervical dilation, involuntary BDEs may
be supported IF the obstetric conditions are conducive to
descent.
Involuntary BDEs can achieve progress in the second stage.
The early phase of second stage should be allowed to
evolve prior to direction to push.
The early phase of second stage should be prolonged and
forceful BDE avoided until the obstetric conditions are
optimal for descent.
The later phase of second stage (active pushing) should be
shortened by assisting the woman with effective BDEs in
order to
minimize the decline in fetal pH
minimize maternal perineal denervation injury
Maternal position and movement can be used to facilitate
effective BDEs and fetal rotation and descent. These positions include
sitting upright
lateral, hanging from side to side
hands and knees, especially if the fetal position is pos
terior
squatting
Direction in forceful BDE should be reserved for when
the mother needs extra encouragement and
obstetrical conditions are optimal for descent.

should assess fetal rotation and descent as indications that

progress is occurring, and, when descent is evident,
instruct the woman in pushing with the contractions as
they are noted on the monitor along with palpation, as
described earlier, so that pushing is coordinated with the
maximal force of the contraction.

Principles for Facilitating Second Stage

The description of phases of the second stage of labor
and the discussion above about the progressive increase in
the quality of BDEs may be summarized in several principles for nursing care that are listed in Table 1. The needs
and progress of labor for women will vary. These principles can provide a basis for interpreting second-stage
progress for individuals in ways that will achieve the best
birth outcomes and maximize womens capabilities to
accomplish a spontaneous birth.

Delay in Descent
The feature of second-stage progress important to
assess in deciding how to assist a woman with BDEs in
Volume 32, Number 6

the second stage is the descent and rotation of the fetal

head. Various maternal positions can facilitate rotation
and descent if the woman is able to change her position.
When mobility is limited or descent does not occur, the
nurse needs to consider what might be delaying descent.
These factors include inadequate uterine contractions,
malposition of the fetal head, cephalo-pelvic disproportion, or unrelieved pain that is interfering with the ability
of the woman to push effectively. The birth attendant
(physician or certified nurse-midwife) should be involved
in this assessment, which may reveal the need for oxytocin to augment contractions, additional analgesia for
pain relief, or instrumental or operative intervention.

he optimal obstetric conditions for descent

with maternal bearing down efforts are
complete or nearly complete cervical dilation;
rotation of the fetal head to an anterior
position; descent of the presenting part
to at least a +1 station; adequate intensity
of uterine contractions (at least 30 mm Hg);
and an involuntary maternal urge to push.

Other Nursing Responsibilities

During Second Stage Labor
In addition to determining when and how a woman is
to bear down and assessing fetal descent, the nurse needs
to consider other critical features of fetal and maternal
status during the second stage. The most available indicator of fetal tolerance of labor is the FHR pattern. The following time intervals for assessing FHR are recommended during the second stage: In the absence of risk factors,
the FHR should be auscultated after a uterine contraction
every 15 minutes; in the presence of risk factors, auscultation or assessment of the EFM should be done every 5
minutes (American Academy of Pediatrics & American
College of Obstetricians and Gynecologists [ACOG],
2002; ACOG, 1995; Association of Womens Health,
Obstetric and Neonatal Nurses, 2000). The Society of
Obstetricians and Gynaecologists of Canada (1995) has
recommended auscultation every 5 minutes for all
patients in the second stage when pushing begins.
The continuation of second stage for any period of
time requires that there be continued fetal descent and no
evidence that the fetus or woman is not tolerating labor.
Indications that the fetus may not be tolerating the second
stage of labor are an increase or decrease in the baseline

November/December 2003

FHR (bradycardia < 110 beats per minute [bpm] or tachycardia > 160 bpm); minimal or absent baseline variability; variable decelerations with progressive loss of variability; late decelerations; or prolonged decelerations
(King & Simpson, 2001). It is reassuring when there are
FHR accelerations, particularly in response to acoustic,
abdominal, or scalp stimulation. The absence of FHR
accelerations (of 15 bpm amplitude lasting 15 seconds)
requires further assessment and continued observation in
conjunction with assessment by the physician. The
appearance of meconium during second stage also
requires further assessment of fetal status along with notification of qualified persons to assist in ensuring adequate
respiration at birth.
Intolerance of labor by the mother is reflected in
fatigue and inability to continue to push. This is most
likely to develop when the woman is encouraged in bearing down before the obstetric conditions are optimal. It
can be minimized by avoiding the arbitrary practice of
directing a woman to push upon complete cervical dilation. When the woman experiences an urge to push
prior to adequate fetal rotation and descent, maternal
fatigue can be minimized by continuing to coach her in
relaxation and slow breathing techniques as a contraction
starts, which results in pushing only at the peak of the
contraction when the urge is irresistible. It is important
that she also remain well hydrated with oral or intravenous fluid, and that her bladder not become overly distended.
These basic features of care in labor are ongoing, along
with offering encouragement and information that minimize her anxiety or concern about progress. It is anxietyproducing for the woman if the nurse or physician performs a vaginal examination during the second stage and
does not share the findings with her (Bergstrom, Roberts,
Seidel, & Skillman, 1992). Discouraging findings on a
vaginal examination can be used as motivation to try
another position for effective pushing or for some other
strategy that will promote rotation, descent, and comfort.
In conclusion, nursing care during the second stage of
labor should be characterized by support to women in
making active decisions about their care and labor management; by strategies to prolong the early passive phase
of fetal descent; support in involuntary bearing-down
efforts; the provision of instruction or assistance, as needed, when the woman enters the later phase of active pushing; and the use of maternal positions that can enhance
descent and are accompanied by less pain. Nurses should
assess all of the obstetric conditions that are related to
progress in the second stage along with maternal and fetal
well-being. Further research is needed to establish parameters for duration of the phases of second stage and the
effectiveness of these supportive strategies to achieve optimal birth outcomes.

JOGNN 799

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Volume 32, Number 6

Joyce E. Roberts, CNM, PhD, is a professor and the director of

the Womens Health and Nurse-Midwifery Program, The Ohio
State University College of Nursing, Columbus.

November/December 2003

Address for correspondence: Joyce E. Roberts, CNM, PhD,

Womens Health and Nurse-Midwifery Program, The Ohio
State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210. E-mail: roberts.44@osu.edu.

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