Variability of clinical practice in the care of the second stage of labor among midwives in Spain

Estíbaliz Laderas Díaz; Julián Rodriguez-Almagro; Juan Miguel Martinez-Galiano; Rafael Picón Rodríguez; Antonio Hernández-Martínez

doi:10.1186/s12912-024-01863-7

Variability of clinical practice in the care of the second stage of labor among midwives in Spain

BMC Nurs. 2024 Mar 26;23(1):202. doi: 10.1186/s12912-024-01863-7.

Authors

Estíbaliz Laderas Díaz¹, Julián Rodriguez-Almagro², Juan Miguel Martinez-Galiano³, Rafael Picón Rodríguez⁴, Antonio Hernández-Martínez⁵

Affiliations

¹ Department of Obstetrics & Gynecology, La Mancha Centro General Hospital, Av. Constitución, 3, Alcázar de San Juan, Ciudad Real, 13600, Spain.
² Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain. julianj.rodriguez@uclm.es.
³ Department of Nursing, University of Jaen, Jaen, Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
⁴ Department of General and Digestive Surgery, Santa B?rbara Hospital, Puertollano, Ciudad Real, 13500, Spain.
⁵ Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain.

Abstract

Background: There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations.

Objective: The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines.

Methods: A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0.

Results: Regarding the woman's position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor.

Conclusions: Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care.

Keywords: Midwife; Obstetrics; Professional practice; Second stage labor; Variability.