Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study

Jiasi Yao; Heike Roth; Debra Anderson; Hong Lu; Huijuan Rong; Kathleen Baird

doi:10.2196/55701

Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study

JMIR Res Protoc. 2024 Mar 26:13:e55701. doi: 10.2196/55701.

Authors

Jiasi Yao^{1

2}, Heike Roth^{3

4}, Debra Anderson², Hong Lu⁵, Huijuan Rong⁶, Kathleen Baird^{3

4}

Affiliations

¹ School of Nursing, Hebei Medical University, Shijiazhuang, China.
² Faculty of Health, University of Technology Sydney, Sydney, Australia.
³ School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia.
⁴ Collective for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia.
⁵ School of Nursing, Peking University, Beijing, China.
⁶ Department of Nursing, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China.

PMID: 38530330
PMCID: PMC11005428
DOI: 10.2196/55701

Abstract

Background: Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as "spontaneous pushing," which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing.

Objective: This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China.

Methods: A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness).

Results: Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives' interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024.

Conclusions: This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women's childbirth experience.

Trial registration: Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft.

International registered report identifier (irrid): DERR1-10.2196/55701.

Keywords: China; Chinese; Midwives; birth; child; childbirth; cohort; delivery; directed pushing; effectiveness; feasibility study; healthcare; labor; labour stage, labour; labouring women; maternal; maternal-neonatal outcomes; midwife; midwifery; obstetric; obstetrics; protocol; second; spontaneous pushing; women.

©Jiasi Yao, Heike Roth, Debra Anderson, Hong Lu, Huijuan Rong, Kathleen Baird. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 26.03.2024.