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

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.

Effect of Timing of Second-Stage Pushing on Pelvic Floor Morbidity After Birth

The author describes a recent trial on the effect of the timing of pushing during the second stage of labor on postpartum pelvic floor morbidity.

Transcutaneous Electrical Nerve Stimulation: An Overview

Pain and its management hold a central place in health care. The pain associated with pregnancy and giving birth is unique in that it is a normal, physiologic phenomenon that is affected by cultural mores, personal experience, and internalized sensations. There are numerous nonpharmacologic tools available to treat discomfort during pregnancy and childbirth. Some methods of nonpharmacologic relief are underutilized, due to the lack of knowledge of the evidence. Childbirth educators, doulas, nurses, and midwives are a prime source of knowledge for birthing families to learn a variety of comfort techniques during pregnancy and labor. The purpose of this article is to discuss the use of transcutaneous electrical nerve stimulation (TENS) as a nonpharmacologic comfort technique.