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Keywords:

  • noncoached pushing;
  • second stage of labor;
  • epidural;
  • perineal laceration

Poster Presentation

  1. Top of page
  2. Poster Presentation

Objective

The literature indicates that noncoached pushing during the second stage of labor may be beneficial to the mother and fetus. Yet most of the research is conducted on women with no epidural. The most common practice at St. Luke's Hospital, as well as elsewhere, is coached pushing, where the patient is told to push three times during each contraction, for 10 seconds each. We aimed to understand factors that influence the use of noncoached pushing, which encourages the woman to listen to her body and push the way she wants and to determine if noncoached pushing for patients with an epidural is feasible. We further examined the relationship between noncoached pushing and several outcome variables.

Design

Quasi-experimental research study using a convenience sample of laboring women.

Patients/Participants

Laboring women with singleton pregnancies who reached the pushing stage of labor.

Methods

Participants were classified as either “coached” or “noncoached.” The influence of parity, use of oxytocin, epidural, time spent laboring down, urge to push, and time spent pushing were initially examined via chi-square analysis, and multivariate direct logistic regression was conducted to determine relationships with episiotomies, operative deliveries, perineal lacerations, and Apgar scores. Additionally, nurses were interviewed about why they used noncoached or coached pushing. Education was provided for nurses and doctors at seminars regarding the research behind the use of noncoached pushing, and its use was encouraged.

Results

The use of noncoached pushing was related to multiparity, labor progression without the use of oxytocin, labor without an epidural, an urge to push at 10 cm, and a shorter time spent pushing (p < .05). In bivariate relationships, noncoached pushing is related to a decrease in episiotomies, operative deliveries, and perineal lacerations (p < .05). Multivariate logistic regression revealed a trend in the data suggesting that noncoached pushing is related to fewer third- and fourth-degree lacerations, even when controlling for other factors (p < .1). In women with epidurals, multivariate logistic analysis revealed a significant relationship between coaching and operative deliveries (p < .05). A common theme in the interviews with nurses was that women who were not pushing effectively were coached during their pushing.

Conclusion/Implications for Nursing Practice

Noncoached pushing during labor may have maternal benefits. Though women without an epidural were more likely to receive noncoached pushing, more than half of women with an epidural still had noncoached pushing. This indicates that having an epidural is not prohibitive of noncoached pushing.