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At least 19 recordsLinked to original sources
PubMedDate not supplied

Second stage labor: what is normal?

Traditional management of second stage labor has come under scrutiny because of improved understanding of what normally occurs when second stage labor is allowed to proceed of its own accord without direction from birth attendants. When women bear down spontaneously as they feel the urge to push, either holding their breath briefly or with short exhalation of air, normal maternal and fetal physiological status is maintained and second stage labor does not appear to be lengthened. Using a variety of maternal positions during second stage labor can optimize physiologic functioning and increase maternal comfort.

Female↗
PubMedDate not supplied

Effect of the birth chair on duration of second stage labor, fetal outcome, and maternal blood loss.

The effect of delivering in a birth chair on duration of second stage labor, fetal outcome, and maternal blood loss was examined in a retrospective study. The sample consisted of 60 primiparous women, 37 to 41 weeks gestation with a normal pregnancy and labor, 30 delivering on a traditional delivery table and 30 delivering in a birth chair. Comparisons were made between groups for mean duration of second stage labor, mean Apgar scores at one and five minutes, and mean maternal hemoglobin and hematocrit values during the pre- and post-partum periods. No significant difference was found between delivery table and birth chair groups for mean duration of second stage labor (birth chair, X = 60 minutes versus delivery table, X = 43 minutes, t = 1.66, p = .10). Mean Apgar scores at one and five minutes were nearly identical. Statistically significant differences existed between groups in mean maternal hemoglobin and hematocrit values. Both the mean hemoglobin and the mean hematocrit upon admission were significantly higher in the birth chair group (p less than .027). However, postpartally the birth chair group had significantly lower mean hemoglobin and hematocrit values (p less than .025). These findings suggest that the birth chair, as an alternate delivery method, is safe in terms of fetal outcome but presents no advantage to the mother in terms of shorter second stage labor. Further investigation of maternal blood loss is recommended to rule out possible untoward effects.

Apgar Score↗
PubMedDate not supplied

Effect of the birth chair on duration of second stage labor and maternal outcome.

The effect of delivering in a birth chair on duration of second stage labor, perineal swelling, incidence of episiotomies, lacerations, hemorrhoids, and maternal blood loss was examined in a prospective quasi-experimental study. The sample consisted of 55 primiparous women, 37 to 41 weeks gestation, with normal pregnancy and labor; 22 delivered on a traditional delivery table (DT) and 33 in a birth chair (BC). Comparisons were made between groups for mean duration of second stage labor, mean time bearing down in the delivery room, mean maternal blood loss, frequency of instrument-assisted deliveries, frequency of episiotomies and lacerations, and frequency of perineal swelling and hemorrhoids. The two groups were statistically similar for weight of infant. No significant difference was found between groups for mean duration of second stage labor (BC M = 55 minutes, DT M = 43 minutes) or mean time bearing down (BC M = 60 minutes, DT M = 53 minutes). No difference was found in the amount of blood loss between the two groups as measured by the mean difference in the pre- and postdelivery hemoglobin (BC M change = 1.4 Gms, DT M change = 1.8 Gms). The lack of significant differences in blood loss may be due to the fact that the angle of the birth chair was lowered during or after delivery in 88% of the cases. The incidence of instrument-assisted deliveries (BC = 7, DT = 6), episiotomies (BC = 27, DT = 20), lacerations (BC = 17, DT = 5), and hemorrhoids (BC = 14, DT = 4) was similar between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1977

Influence of the duration of second stage labor on perinatal outcome and puerperal morbidity.

Obstetric data from 4403 nulliparas were analyzed in order to determine whether the duration of the second stage of labor influences perinatal outcome or maternal puerperal morbidity. No significant increase in the frequency of perinatal mortality, neonatal mortality, or low 5-minute Apgar scores was noted with long second stages. An increase in the incidence of low 1-minute Apgar scores was observed only in those infants who were not monitored. An increase in puerperal hemorrhage after more than 3 hours of second stage labor was attributable to those patients delivered by midforceps operations. It appears that it is unwarranted to terminate labor simply because an arbitrary period of time has elapsed in the second stage.

Apgar Score↗
PubMed1980

Duration of the second stage of labor.

The second stage of labor, defined as the time from full dilatation of the external os to delivery of the child, was recorded during a three-month period in 635 labors with vaginal delivery. The median duration in labors of spontaneous onset was 31.3 minutes in para 0 mothers, 14.3 minutes in para 1 mothers and 11.7 minutes in para 2 + mothers. In induced labors the second stage had approximately the same length as in labors with spontaneous onset. The time distribution showed that the second stage in para 0 mothers had a plateau in the 17.5--37.5 minute range, whereas para 1 + mothers had a sharper peak at 7.5 minutes. Forty and 45 minutes respectively seemed to be limits beyond which only very few second stages of labor lasted. Operative delivery terminated 18 per cent of para 0 labors and 6 per cent of the para 1 + labors entering the second stage. The operative interventions seemed to appear in two clusters for each parity group. It appeared that fetal asphyxia requiring intervention was discovered before 40 minutes of the second stage in para 0 and before 30 minutes in para 1 + mothers. Later operative termination was more often performed to relieve fatigued mothers.

Cesarean Section↗
PubMed1980

FHR variability and other heart rate observations during second stage labor.

Seventy-four fetal heart rate (FHR) records that were continued to vaginal delivery were selected for study from more than 2000 intrapartum FHR tracings. Thirty-six of the births were associated with neonatal depression and Apgar scores of 3 or less and/or 6 or less at 1 and 5 minutes, respectively; 38 patients exhibited normal Apgar scores (7 and 10 at 1 and 5 minutes, respectively). Twenty minutes of heart rate activity immediately prior to birth was the basis of analysis. All categories of loss of short-term beat-to-beat variability (BBV), both baseline and with decelerations, were observed more frequently in the group with low Apgar scores (P less than .001). In assessing variability, duration of observed loss of BBV appears to be an extremely critical factor. If BBV was lost 50% or less of observation time, a wide range of Apgar scores was observed. When more than 50% of the record showed loss of BBV, the number of depressed neonates was relatively high. Bradycardia (heart rate of less than 120 beats per minute) was present frequently in the records of the normal group. The number of variable decelerations and the amount of uterine activity were relatively high during second stage labor; a similar frequency was noted in both groups. Decelerations were nearly uniformly associated with uterine contractions in both groups, and accelerations were also noted in both groups. Uniform decelerations (late) were also present in both groups, with a greater frequency in the group with lower Apgar scores, but there were no distinguishing characteristics noted.

Apgar Score↗
PubMed1992

Reliving birth: maternal responses to viewing videotape of their second stage labors.

To learn about women's responses to their second stage labors and the care they received, women (N = 20) whose second stage labors had been videotaped were interviewed postpartally and shown their videotapes. Often women found the videotape viewing to be intensely emotional, especially when they heard noises they made. Women frequently commented upon details they hadn't remembered, their reactivated memory for labor pain, and the "weird" experience of watching themselves in labor. The authors recommend that women who watch their labor videotapes do so with a caregiver or supportive companion. They should be forewarned that the experience may be intense; details of their labors may be vividly recalled or women may see labor events on the videotape of which they were previously unaware.

Adolescent↗
PubMedDate not supplied

Obstetrics by ear. Maternal and caregiver perceptions of the meaning of maternal sounds during second stage labor.

In a study at the University of Colorado School of Nursing, Department of Nurse-Midwifery, women's second stage labors were videotaped to study caregiver behavior during second stage labor. Postpartum interviews of the mothers (n = 10) and caregivers (n = 16) were conducted to learn about their responses as they viewed the videotapes. Qualitative analysis was conducted of the transcribed interviews using the Ethnograph computer software. One of the themes emerging from the data was the significance of maternal sounds. Both caregivers and mothers were able to articulate differences between adaptive and nonadaptive sounds according to their quality, pitch, feeling state, and accompanying verbalizations. Data about women's second stage labor sounds have been categorized according to the following maternal states: work/effort, coping, childlike, out-of-control, and with epidural anesthesia. Typical sounds/verbalization, significance, and facilitative caregiver responses are defined for each category. It is concluded that when a "no noise" rule is evoked during second stage labor, valuable behavioral cues are unavailable to guide caregiver behavior.

Adaptation, Psychological↗
PubMedDate not supplied

Phases of second stage labor. Four descriptive case studies.

In recent years, the second stage of labor has become an area of interest to a number of observers who have described divisions or phases with behavioral characteristics. Using a descriptive case study design, four normal nulliparous women in spontaneous second stage labor were videotaped from the occurrence of involuntary bearing-down efforts or the recognition of complete cervical dilation until birth. Analysis of these videotapes, the accompanying narrative transcripts, and uterine monitor tracings provided evidence that some behaviors changed over the progression of the second stage. These changes could be divided into three behavioral phases that the nurse/midwife can identify in order to recognize the typical pattern of progression and possible deviations from normal.

Adaptation, Psychological↗
PubMedDate not supplied

Maternal fatigue: implications of second stage labor nursing care.

The parameters of fatigue have been studied in recent years in relation to women's health and the childbearing period. Less research emphasis has been placed on second stage labor, a period of time that can encompass considerable physiologic and psychologic fatigue. Consideration to minimizing second stage labor fatigue by altering conventional support practices is needed. This includes minimizing long periods of strong pushing or bearing down efforts in conjunction with sustained breath holding, particularly for women receiving epidural anesthesia. The potential sequelae of second stage labor fatigue, recommendations for practice changes, and new research directions are discussed.

Fatigue↗
PubMedDate not supplied

Use of fundal pressure during second-stage labor. A pilot Study.

Fundal pressure is a controversial obstetric technique used by some practitioners in second-stage labor. In this preliminary study, 34 deliveries in which fundal pressure was used to expedite birth were matched with 34 deliveries that occurred spontaneously. Several parameters were compared between the two groups. In the group of women who were delivered with use of fundal pressure, second-stage labor was longer and a higher incidence of third- and fourth-degree perineal lacerations was observed compared with those women who delivered spontaneously. This article discusses the possible reasons for these findings, the reasons fundal pressure was used, and the controversial issues that surround this technique.

Adult↗
PubMed1989

[A 1-year study of the management of fetal breech presentation by monitoring follow-up during second-stage labor instead of using external version, x-ray pelvimetry and ultrasonic assessment of fetal weight].

The authors studied 246 parturients with breech presentation of the fetus. All women were examined by an obstetric monitor. Cesarean section was performed on 33 women/ = 13.41% of women with breech presentation). Perinatal morbidity and mortality were the same as those of women with vertex presentation. The frequency of cesarean section was 11.98% of multiparas and 31.57% of nulliparas. According to the authors careful observation of advancement of delivery as well as the state of the fetus (by an obstetric monitor) could lead to management of delivery with breech presentation just as that of vertex presentation. This management of breech presentations should reduce the fear of delivery, which is observed in most parturients with breech presentation of the fetus.

Body Weight↗
PubMed1996

The modified Mueller-Hillis maneuver in predicting abnormalities in second stage labor.

OBJECTIVE: To assess prospectively the utility of a modification of the Mueller-Hillis maneuver in predicting abnormalities of the second stage of labor. METHODS: The Mueller-Hillis maneuver was modified by limiting its use to the second stage of labor during a contraction. The maneuver was performed by one examiner; descent of 1 cm or more was deemed a positive maneuver. Descent less than 1 cm was deemed a negative maneuver. Labor outcomes were analyzed according to the results of this maneuver. RESULTS: Seventy patients were enrolled in this study. Fifty-one (72.9%) had > or = 1 cm descent maneuver and 19 (27.1%) had < or = 1 cm descent. A descent > or = 1 cm was significantly predictive of vaginal delivery (100%) and a descent < or = 1 cm was significantly associated with an increased cesarean section rate (P = 0.001), prolonged second stage of labor (P = 0.001), abnormal position (P = 0.01) and higher station (P = 0.001). CONCLUSIONS: A positive modified Mueller-Hillis maneuver in second stage labor had a high predictive value for vaginal delivery, whereas a negative maneuver was significantly associated with high operative delivery rate, prolonged second stage labor and abnormal position. These results indicate that this modification of the Mueller-Hillis maneuver needs to be considered for its utility in second stage labor.

Adult↗
PubMed1990

Women's views of second-stage labor as assessed by interviews and videotapes.

Twenty women were selected from public and private maternity services and interviewed by nurses and nurse-midwives on a research team. The women were shown videotapes of their second-stage labors that for 15 of them had been recorded by 2 other members of the research team. Four videos were provided by mothers who had had home births and one from a mother whose birth was filmed at a birth center. The interviews were analyzed for major themes; the theme reported here is women's experiences of pushing. Women reported wide variations in sensations during the second stage. Whereas 9 of 16 women expressed feelings of relief or pressure and stretching, 7 described pushing as painful, miserable, or horrible. Thirteen of 19 women had well defined urges to push, 1 had an intermittent urge, and 5 had no urge. Women often felt unprepared for the sensations and work of second-stage labor, and caregivers' instructions commonly did not seem to be in synchrony with physiological responses. We conclude that childbirth educators and caregivers must prepare women more realistically for the second stage. They would be more effective if they responded to maternal behavior, rather than giving arbitrary instructions about pushing.

Adolescent↗
PubMed1997

"I gotta push. Please let me push!" Social interactions during the change from first to second stage labor.

BACKGROUND: Forms of social interaction may occur among the participants in medicalized births, in which a woman in labor is experiencing strong involuntary urges to push but has not yet been found to have a completely dilated cervix. This article examines the social events and communications that occur at the change between first and second stages of labor. METHOD: Three cases are described from videotapes of women in the second stage of labor and their caregivers. RESULTS: Several social and interactive features occurred, in which (1) the caregiver, usually a nurse, by invoking the "no pushing rule," insisted that the woman suppress her involuntary urges to push; (2) both the caregiver and the parturient displayed an orientation toward the future and the eventual certification of full cervical dilation by a designated authority, usually a physician, regardless of the actual state of the woman's cervix or her involuntary urges to push; and (3) the certification process marked a ritual transition to "official" second stage labor, in which the woman's involuntary urges were considered appropriate and actively encouraged. CONCLUSION: A discrepancy between a laboring woman's sensations and caregivers' ideas about how labor should be conducted has implications for clinical care of women, wherein the goal should be to facilitate the woman's accomplishment rather than to direct the "delivery."

Adult↗
PubMed1997

Nursing management of second stage labor.

Despite considerable research into nursing management of second stage labor, traditional approaches continue to predominate. Women are still encouraged to deliver in a recumbent position using sustained, closed-glottis pushing. Current research suggests that utilizing an upright position with pushing that is open glottis and complementary with the involuntary bearing-down reflex produces good maternal/fetal outcomes. Issues such as position, second stage phases, and bearing-down techniques are discussed in view of recent research findings. Gaps in knowledge are identified and practice implications are clearly defined. Now is the time to apply research-based knowledge to nursing management of second stage labor.

Journal Article↗
PubMed1991

A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor.

Two hundred ninety-four women were randomly allocated to a group in which the use of a birthing stool (experimental group) or a conventional semirecumbent position (control group) was encouraged. The birthing stool was 32 cm high and allowed the parturient to sit upright and to squat. The husband could sit close behind his wife and support her back. No differences were observed between the two groups regarding mode of delivery, length of the second stage of labor, oxytocin augmentation, perineal trauma, labial lacerations, or vulvar edema. Infant outcome measured by Apgar scores at 1 and 5 minutes postpartum and numbers of neonatal intensive care unit transfers was the same in both groups. Mean estimated blood loss and the number of mothers with a postpartum hemorrhage 600 ml or more were greater in the experimental group than in the control group. Women in the experimental group reported less pain during the second stage of labor, and they and their spouses were more satisfied with the birth position than were parents in the control group. Midwives were less satisfied with their working posture in the experimental group.

Adult↗