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. 2020 Apr 1;29(2):72-82.
doi: 10.1891/J-PE-D-19-00014.

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

Renece Waller-Wise, Stephanie Lewis, Barbara Williams

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

Renece Waller-Wise et al. J Perinat Educ. .

Abstract

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.

Keywords: delayed pushing; evidence-based guidelines; laboring down; maternal positioning; physiologic pushing; second-stage labor.

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