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Topic Suggestion Description

Date submitted: January 13, 2015

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

TOPIC Physiologic second stage of laborWomaninitiated spontaneous pushing the second stage of labor begins at the time the woman feels the urge to push. Spontaneous pushing is defined as a womans response to a natural urge to push or a bearing down effort that comes and goes several times during each contraction. It does not involve timed breath holding or counting to 10. What is the evidence about outcomes of physiologic second stage as compared to coached closed glottis pushing in second stage for the mother possible outcomes are length of active second stage perineal outcome instrumentassisted vaginal birth rate cesarean rate blood loss maternal satisfaction with second stage labor maternal postpartum fatigue postpartum bladder function pelvic organ prolapse For the infant possible outcomes are Apgar scores at 1 minute and 5 minutes venous and arterial cord blood gases breastfeeding How does upright and lateral positioning vs. recumbent and semirecumbent positioning promote progression of second stage of labor All women preparing for birth and experiencing the second stage of labor.Benefits of physiologic second stageMaternalSpontaneous vaginal birth Intact perineumFeelings of selfefficacy in second stageFunctional bladder postpartumNeonatal wellbeingcardiovascular respiratory and metabolic stability breastfeeding in first hours of lifePotential harms of closed glottis pushing during second stageMaternaloLonger duration of second stage of laboro paino Increased risk for operative assisted birthsoCV changesoPetechial hemorrhageso frequency perineal trauma including but not limited to increased need for episiotomy lacerationso satisfaction with pushingo postpartum fatigueoPostpartum bladder capacity first urge to void pelvic organ prolapse riskFetusnewbornometabolic disturbanceo neonatal depression

Describe why this topic is important.

Despite several decades of evidence supporting advantages for both a woman and her infant when the physiologic process of second stage is supported by caregivers these practices are still not consistently applied in birth settings. Instead when women are coached in second stage to do prolonged Valsalva breath holding with a closed glottis and not permitted to push in an upright or lateral position there is potential for adverse effects for both the woman and her infant.Evidence reveals that any upright or lateral position during the second stage of labor results in less pain and perineal trauma and fewer episiotomies operative assisted births and FHR abnormalities BodnerAdler et al. 2003 de Jong et al. 1997 Downe Garrett Renfrew 2004 Ragnar et al. 2006Roberts Algert Cameron Torvaldsen 2005 Schiessl et al. 2005.

How will an answer to your research question be used or help inform decisions for you or your group?

A systematic review addressing these questions will support AWHONNs upcoming revision of the Nursing Care and Management of the Second Stage of Labor evidencebased guideline . A systematic review could be used by those implementing second stage of labor quality initiatives like the one implemented in Michigan by the Michigan Health and Hospital Associations Keystone Center. The systematic review can support widespread adoption of physiologic second stage practices by all maternity care professionals which has the potential to improve maternal and newborn outcomes and reduce costs.

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
professional society
If you are you making a suggestion on behalf of an organization, please state the name of the organization
Association of Womens Health Obstetric and Neonatal Nurses AWHONN and American College of NurseMidwives ACNM
Please tell us how you heard about the Effective Health Care Program
Collaboration with AHRQ to increase nurses awareness and use of the EHC program.