References

Anim-Somuah M, Smyth R, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011; 7:(12) https://doi.org/https://doi.org/10.1002/14651858.CD000331.pub3

Gimovsky AC, Berghella V. Randomized controlled trial of prolonged second stage: extending the time limit vs usual guidelines. Am J Obstet Gynecol. 2016; 214:(3)361.e1-361.e6 https://doi.org/https://doi.org/10.1016/j.ajog.2015.12.042

Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol. 2014; 124:(1)57-67 https://doi.org/https://doi.org/10.1097/AOG.0000000000000278

Lavender T, Hart A, Smyth R. Effect of partogram use on outcomes for women in spontaneous labour at term. Cochrane Database Syst Rev. 2013; 10:(7) https://doi.org/https://doi.org/10.1002/14651858.CD005461.pub4

Health and Social Care Information Centre. Hospital Episode Statistics: NHS Maternity Statistics—England, 2013–14. 2015. http://content.digital.nhs.uk/catalogue/PUB16725/nhs-mate-eng-2013-14-summ-repo-rep.pdf (accessed 23 April 2017)

National Institute of Health and Care Excellence. Intrapartum care for healthy women and babies [CG90]. 2014. http://tinyurl.com/y77car7p (accessed 23 April 2017)

National Institute of Health and Care Excellence. Developing NICE guidelines: the manual. 2017. https://www.nice.org.uk/guidance/cg190/resources/intrapartum-care-for-healthy-women-and-babies-35109866447557 (accessed 5 July 2017)

Nursing and Midwifery Council. The Code. 2015. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf (accessed 23 April 2017)

Rouse DJ, Weiner SJ, Bloom SL Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Am J Obstet Gynecol. 2009; 201:(4)357.e1-357.e7 https://doi.org/https://doi.org/10.1016/j.ajog.2009.08.003

Royal College of Obstetricians and Gynaecologists. Operative vaginal delivery. [CG26]. 2011. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_26.pdf (accessed 23 April 2017)

Yli BM, Kro GA, Rasmussen S, Khoury J, Norèn H, Amer-Wåhlin I, Saugstad OD, Stray-Pedersen B. How does the duration of active pushing in labor affect neonatal outcomes?. J Perinat Med. 2011; 40:(2)171-178

Does extending time limits in the second stage of labour compromise maternal and neonatal outcomes?

02 August 2017
10 min read
Volume 25 · Issue 8

Abstract

Background:

Guidelines on intrapartum care may be based on outdated evidence that suggests that a prolonged second stage of labour is dangerous to both mother and baby.

Aims:

To examine the maternal and neonatal effects of extended second stage labour.

Methods:

Medical databases were searched, and a critical appraisal skills programme (CASP) tool used. This narrowed down the number of included studies to four, which were then critiqued.

Findings:

This literature review found that, as length of second stage increased, so did chance of spontaneous vaginal delivery. However, prolonged pushing was associated with slightly increased rates of chorioamnionitis and severe perineal trauma. Adverse outcomes were linked predominantly to the mothers but some minor neonatal effects were also noted.

Conclusion:

In alignment with the NMC Code, care plans should be formed in partnership with women and only after considering her individual circumstances and wishes. Health professionals should view guidelines as recommendations, rather than rules that must not be broken and instead consider the wider picture when dealing with extended second stage of labour.

The second stage of labour is defined as full cervical dilation until delivery of the baby. In fact, it is so much more. The woman embodies both physical strength and emotional vulnerability as with each push she journeys closer to the life changing rite of passage that is motherhood. Labour has long been conceptualised into stages with measurements and time limits. In 1954, EA Friedman devised the partograph, enabling women's labours to be managed with time constraints and boundaries. Despite a Cochrane review (Lavender et al, 2013) concluding that the use of the partograph was not recommended, this approach continues to underpin midwifery practice, potentially resulting in superfluous physical and emotional suffering for women undergoing interventions to shorten their labour.

This literature review sought to investigate whether low risk mothers and babies suffered adverse effects when the second stage of labour was extended beyond ‘normal’ time limits. These limits are defined by the National Institute for Health and Care Excellence (NICE) (2014) as 3 hours in primiparous women and 2 hours in multiparous women; however, the Royal College of Obstetricians and Gynaecologists (RCOG) (2011) and Trust guidelines provide conflicting advice, meaning that it can be difficult to gain consistency and promote normality.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month