Birth of a Culture Change Enhances Safety during Second Stage of Labor


Paper Presentation

Purpose for the Program

To identify signs of maternal or fetal stress during the second stage of labor and remove barriers to timely responses of care providers.

Proposed Change

To modify the culture in which experienced nurses independently manage nursing care during the second stage of labor.

Implementation, Outcomes, and Evaluation

Tested strategies were used that contribute to quality care: uniform processes, careful surveillance, team communication, and empowerment of each member of the team. The program consists of a group page to alert the entire team of the onset of the second stage of labor, identification of four essential assessments necessary for safe passage, and the inclusion of a designated experienced nurse to provide a second pair of eyes to the situation. The latter is critical as a single nurse may be caught up in the details of the situation and lose the greater perspective. The ability to safely monitor fetal status, adequacy of contractions, absence of tachysystole, and progress of descent can present challenges in long labors. This is especially true when competing priorities, such as complex birth plans, medical complications, or a very busy unit divert attention. The second pair of eyes enhances recognition of problems and hastens interventions through collegial communication. This collegiality imparts strength and confidence to the less experienced nurse in knowing when to speak up. Outcomes have been fewer incidents of unrecognized maternal or fetal stress, improved teamwork, and greater nurse satisfaction.

Implications for Nursing Practice

Implications for nursing practice include knowing that working within uniform processes in a strong teamwork environment enhances safety during a critical time in labor. Implications also include a sense of empowerment to support both laboring women and each other, especially during a prolonged second stage of labor.