Effects of an Interdisciplinary Practice Bundle for Second-Stage Labor on Clinical Outcomes

Improving Nurse Management of the Second Stage of Labor

OBJECTIVE

To develop, implement, and evaluate an educational program to improve nurses' management of the second stage of labor.

DESIGN

Evidence-based practice project guided by the Iowa Model-Revised.

SETTING

Acute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery.

PARTICIPANTS

Eighteen registered nurses participated in the educational intervention.

INTERVENTION

An instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal-fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions.

MEASUREMENTS

Data collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing.

RESULTS

Second-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%.

CONCLUSION

Based on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.

A Quality Improvement Project Utilizing a Clinical Practice Guideline in Women During Second-Stage Labor

Second-stage labor is the most challenging stage of labor, as it requires increasing exertion of the birthing woman. Variances in nursing interventions in second-stage labor have an influence on outcomes. There is disparity in nursing care during second-stage labor. The purpose of this project was to evaluate a clinical practice guideline in second-stage labor with respect to positioning, timing of pushing, type of pushing effort, and the effect on birth method and perineal trauma. Spontaneous vaginal birth increased, vacuum extraction birth decreased, and vaginal birth after cesarean doubled. The rate of episiotomy decreased, the rate of multiple types of lacerations decreased, the rate of vaginal wall tears decreased, and the need for wound suturing of birth acquired lacerations decreased.

Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body's Urge to Push

Tradition, not evidence, continues to drive the management of the second stage of labor in most hospitals. This is an overview of current evidence associated with best practices for healthy outcomes for mothers and babies.