Problem: Although there are two methods of nursing care for women with epidural analgesia during second stage labor (coached closed-glottis pushing immediately at 10 centimeters cervical dilation or passive fetal descent and delayed pushing until the woman feels the urge to push), there are limited data concerning which method is most optimal for fetal wellbeing. Purpose: To evaluate the effects on fetal wellbeing of two methods of nursing care during second stage labor. A physiologic framework was used to guide the study. Methods: Forty-five nulliparous women in the second stage were randomized to immediate pushing or delayed pushing. Fetal oxygen saturation (FSpO2) and the fetal heart rate (FHR) were continuously monitored. FSpO2 values at 10 cm dilation, initiation of pushing and prior to birth and the amount of time that FSpO2 values were abnormal (2 or more minutes <30%) were compared between groups. Results: There was a significant difference between groups in the decrease in FSpO2 over the course of the second stage (immediate M=12.45; delayed M=4.56, p=.001). Ninety-four percent of the 2 minute epochs of desaturation (FSpO2 <30%) occurred during active pushing. There were more variable FHR decelerations in the immediate pushing group (immediate M=22.41; delayed M=15.61, p=.019). Conclusions: The delayed pushing method results in less of a decrease in FSp02 during the second stage, less periods of FSpO2 below 30%, and less FHR decelerations as compared to the immediate pushing method, thus delayed pushing is more favorable for fetal wellbeing during second stage labor. Delayed pushing did not increase risk of operative vaginal birth or cesarean birth. Second stage nursing care has an impact on fetal wellbeing and the transition to extrauterine life. Supported by a Grant from the American Nurses Foundation sponsored by GlaxoSmithKline.
Session #1206 - Childbearing
The 29th Annual MNRS Research Conference (April 1-4, 2005)