Provider Support of Spontaneous Pushing During the Second Stage of Labor


  • Carolyn M. Sampselle,

    Corresponding author
    1. Carolyn M. Sampselle, PhD, RNC, FAAN, is the Carolyne K. Davis Collegiate Professor at the University of Michigan School of Nursing, Ann Arbor.
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  • Janis M. Miller,

    1. Janis M. Miller, PhD, RNC, is an assistant research scientist at the University of Michigan School of Nursing, Ann Arbor.
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  • Yuwadee Luecha,

    1. Yuwadee Luecha, PhD, RN, is an associate professor in the Ramathibodi School of Nursing, Mahidol University, Thailand.
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  • Kathryn Fischer,

    1. Kathryn Fischer, RN, MS, CNM, IBCLC, is an instructor at Northwestern Michigan College, affiliated with Munson Medical Center, Traverse City, Michigan.
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  • Lisabeth Rosten

    1. Lisabeth Rosten, RN, MSN, CNM, is an associate in gynecology and obstetrics affiliated with St. Joseph Hosptial–Ann Arbor, Brighton, Mighigan.
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Address for correspondence: Carolyn M. Sampselle, University of Michigan School of Nursing, 400 N. Ingalls, Room 4236, Ann Arbor, MI 48109-0482. E-mail:


Objective: To describe the association between provider communication and actual maternal pushing behavior in second-stage labor and to test differences in length of second stage and total maternal pushing time by maternal pushing behavior.

Design: Descriptive.

Setting: Midwest hospital birth unit.

Participants: Twenty primigravidas who gave birth vaginally.

Intervention: Type of provider communication (supportive of spontaneous or directed pushing).

Main Outcome Measure: Maternal pushing behavior (spontaneous or directed) documented by videotape review.

Results: The percentage of provider communication supporting spontaneous pushing versus directed pushing and the percentage of actual spontaneous versus directed maternal pushing behavior were associated (Pearson r= .80, p= .001, for spontaneous and r= .89, p= .001, for directed). Neither duration of second stage (t= .06, p= .95) nor time spent pushing (t= .15, p= .89) differed by spontaneous versus directed pushing style.

Conclusion: The proportion of spontaneous pushing by the birthing woman was positively and significantly associated with the proportion of caregiver communication supporting and encouraging spontaneous pushing. Importantly, spontaneous pushing did not significantly lengthen the duration of second-stage labor or total time spent pushing.