Pushing methods for the second stage of labour What is the issue?
Abstract Childbirth educators can have a significant impact on safe care for mothers and babies during the second stage of labor. In this guest editorial, educators are encouraged to make sure they are knowledgeable about the latest evidence for best second-stage-care practices so they can adequately prepare women to Prolonged pushing for themselves during this time.
Pregnant women and their families need accurate, science-based information to advocate for themselves and their care in full partnership with nurses, nurse midwives, and physicians.
In addition to focusing on what to expect during labor and how to handle contraction pain and discomfort, pregnant women are often concerned about their ability to push their baby out when the time comes. They may hear from friends and family of long, exhausting hours of pushing while, in contrast, they observe television portrayals of women who usually give birth after only one or two pushes.
Information presented in childbirth preparation classes provides a foundation for expectations of how care will be provided and what women need to know to safely complete the last part of labor before birth.
These techniques have the potential to cause harm to the mother and baby Simpson, Nursing Management of the Second Stage of Labor A recent review of the literature Roberts, provides additional information. Staying current with rigorous Prolonged pushing related to labor and birth is crucial for childbirth educators so they are able to provide women and their families with the best information available to promote safe care.
There are two phases to the second stage of labor: The most stressful period of labor for the fetus is the active pushing phase; thus, shortening this phase minimizes fetal stress and promotes fetal well-being Caldeyro-Barcia, ; Caldeyro-Barcia et al.
The latent phase is an ideal time to allow the woman to rest in preparation for pushing efforts at the appropriate time Roberts, When the time is right for pushing, the best approach based on current evidence is to encourage the woman to do whatever comes naturally.
Positioning is an important component of safe and effective pushing. Encourage the woman to choose a position of comfort and to change positions as often as needed. Many care providers fail to realize that their aggressive coaching techniques are the cause of nonreassuring FHR patterns Simpson, If the fetus continues to respond poorly—as evidenced by abnormal changes in the FHR and recurrent variable or late decelerations—and there is a compelling reason to continue pushing, pushing with alternate contractions works best.
The woman should be assisted to a lateral position. A baseline FHR should be able to be identified between contractions. If the fetus does not respond well to pushing, the best approach is to stop pushing temporarily and let the fetus recover.
Evidence suggests that, for women with epidurals, coached pushing beginning immediately at 10 cm does not result in a clinically significant decrease in the length of the second stage Fraser et al.
Passive fetal descent will result in about the same length of the second stage for women with epidural anesthesia as does the coached-pushing approach.
The FHR pattern should be used as an indicator as to how well the fetus responds to second-stage labor Simpson, In addition, the fetus may develop metabolic acidosis if this type of pattern continues over a long period Parer et al. These babies are difficult to resuscitate and may not transition well to extrauterine life.
Pregnant women and their families can overcome this limitation if they are fully informed and prepared to ask for selected care processes. Childbirth educators help to facilitate this knowledge. For women who choose to use a birth plan, consider sharing the information in Table 1 to add to their birth plan as requests for second-stage labor care.
Allow me to bear down and hold it as long as I feel comfortable. Allow me to keep my feet flat on the bed if I choose to push in that position. Allow my perineum to stretch naturally.
Open in a separate window Often, childbirth educators are not well connected to other members of the perinatal team; however, they can take the initiative to be more active team members by sharing information and participating in discussions about the latest evidence applicable to clinical practice during labor and birth.
Make an effort to coordinate childbirth education content with those who provide the care during labor and birth. Arrange to observe clinical practice during second-stage labor. If practices are not consistent with current evidence and AWHONN clinical guidelines, work with care providers to promote change.
Discuss best practice during second-stage labor with physicians and nurse leaders. Offer to share the information in Table 2. Include additional pertinent literature as well, some of which is listed in the reference list below.
Change to a lateral position or other positions of comfort as necessary. Instead, instruct the woman to bear down and allow her to choose whether or not to hold her breath while pushing. Push with every other or every third contraction if necessary to avoid recurrent FHR decelerations.
Reposition as necessary to treat FHR decelerations. Use the fetal response to pushing as a guide for second-stage care. Make sure that contractions are no closer than every 2 to 3 minutes while pushing.Comparison 2: Delayed pushing versus immediate pushing (women with epidural) For the timing of pushing: delayed pushing versus immediate pushing (all women with epidural) - delayed pushing was associated with an increase in the duration of the second stage by about 56 minutes (very l ow- quality evidence).
Pushing, for many mothers, is a powerful reflex that requires considerable effort to breathe through rather than to push through. Breathing Techniques for Pushing The breathing techniques used for pushing are varied and depend upon which works best for you. Background on Prolonged Second Stage of Labor.
In the past, a prolonged pushing phase was defined as pushing for >3 hours in first-time mothers with an epidural, >2 hours in first-time mothers without an epidural, >2 hours in experienced mothers with an epidural, and > 1 hour in experienced mothers without an epidural (ACOG, ).
Risks of Prolonged Labor Childbirth is a unique experience for every woman, whether you're a first-time mom or a longtime parent.
Sometimes, the baby comes really fast. Epidural anesthesia is the most common form of anesthesia used in childbirth. Since an epidural numbs the entire area between your breasts and knees, you might wonder how .
With epidural anesthesia, pushing can be delayed up to 2 hours for nulliparous women and up to 1 hour for multiparous women (Hansen, Clark, & Foster, ; Simpson & James, ).
There are two phases to the second stage of labor: the initial latent phase and the active pushing phase (Roberts, ).