Can antenatal education influence how women push in labour?
A Pilot Randomised Controlled Trial on Maternal Antenatal Teaching for Pushing in Second Stage of Labour (PUSH STUDY)
Article first published online: 15 JUN 2009
© 2009 The Authors. Journal compilation © 2009 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 49, Issue 3, pages 274–278, June 2009
How to Cite
PHIPPS, H., CHARLTON, S. and DIETZ, H. P. (2009), Can antenatal education influence how women push in labour?. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: 274–278. doi: 10.1111/j.1479-828X.2009.00984.x
- Issue published online: 15 JUN 2009
- Article first published online: 15 JUN 2009
- Received 5 August 2008; accepted 25 December 2008.
- antenatal education;
- randomised trial;
- second stage of labour
Background: Antenatal education on the physiology of second stage of labour and effective pushing has not been studied in the literature. Anecdotal observation seems to indicate that some nulliparous women are (at least initially) unable to push effectively. A large proportion seem to reflexly contract the levator ani muscle when asked to push which may have the effect of slowing the progress of labour.
Aims: To test the effectiveness of structured antenatal education for pushing in the second stage of labour versus normal care and its impact on delivery outcome.
Methods: One hundred nulliparous women between 35 and 37 weeks gestation were randomised. Intervention: Two 15-min structured education sessions, one week apart, utilising observation of the perineum and a vaginal examination to teach correct technique for relaxing the levator ani muscle and effective pushing.
Results: In both groups, 31 of 50 women (62%) delivered vaginally. Instrumental delivery and caesarean section rates did not differ between the two groups (P = 0.78, relative risk = 1). The mean duration of active second stage for the control group was 53.96 min compared with 57.26 min for the intervention group. This difference of 3.3 min was not statistically significant (P = 0.56). Knowledge of women in the intervention group was increased and the majority of women found the educational sessions helpful.
Conclusion: Antenatal teaching to ensure effective maternal pushing in labour did not result in altered obstetric outcomes relative to the control group. However, there was a measurable qualitative effect from the intervention in that women clearly felt the education sessions to be helpful.