Midwives' approaches to early pushing urge in labour
The objectives of this mixed-methods study were: a) to investigate midwives' approaches to early pushing urge (EPU); and b) to explore midwives' perspectives and experiences of helping women cope with EPU. A quantitative observational methodology was adopted to investigate midwives' approaches to EPU in 60 cases. A qualitative phenomenological approach was carried out in order to gain more in-depth understanding of midwives' views and experiences of EPU management strategies. It was found that midwives mainly adopt two approaches in the case of EPU: letting the woman do what she feels, and a stop-pushing technique. The findings are presented as four main domains: a) midwives' approaches to EPU; b) drivers guiding midwives' approaches to EPU; c) influencing factors in helping women cope with EPU; d) variation of midwives' approaches to EPU over time.
Early pushing urge (EPU) is defined as the perception of the irresistible urge to push by the labouring woman before full cervical dilatation, confirmed by vaginal examination. Although different incidence rates are reported in the literature (from 7.6 to 54%), a significant minority of childbearing women seem to experience the EPU phenomenon during labour (Roberts et al, 1987; Downe, 2008; Borrelli et al, 2013). Consequently, midwives are often called to help women cope with this event (Petersen and Besuner, 1997). Occipito-posterior fetal position is often recognised as the factor that is most likely to cause an early pushing urge (Borrelli et al, 2013), although bulging membranes and full rectum are also anecdotally associated with EPU. The EPU has been traditionally considered as a pathological event, with a number of authors highlighting the increased risk of cervical damage and maternal exhaustion (Berkeley et al, 1931; Benyon, 1957; Gaskin, 1990). More recently, researchers have reconsidered EPU as a physiological phenomenon when good maternal and fetal conditions are present (Enkin et al, 2000; Downe, 2008; Borrelli et al, 2013). However, the real incidence of EPU, the nature of the phenomenon and the optimum approach to management remain controversial areas. Moreover, despite EPU appearing to be a common event occurring in a number of labouring women, national Italian guidelines (SNLG-ISS, 2014), UK recommendations (National Institute for Health and Care Excellence (NICE), 2014), and local protocols seem to be incomplete in this area.
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