For instrumental delivery, a pudendal block may be indicated, especially for forceps delivery. As of Sept. 1, 2020, the British Columbia College of Nursing Professionals (BCCNP) and the College of Midwives of British Columbia amalgamated to become the British Columbia College of Nurses and Midwives (BCCNM): Multiple reviews have demonstrated that a policy of restricted episiotomy (episiotomy only when necessary) has better maternal outcomes than a policy of routine episiotomy, with no adverse effects for the newborn , . [Medline] . NURSING MANAGEMENT OF SECOND STAGE OF LABOUR 1. A worldwide KAP survey, Task shifting. While the traditional Pinard stethoscope (fetoscope) may be adequate in very quiet labor rooms, it is often difficult to use reliably owing to surrounding noise or maternal obesity, and especially in the second stage because of the woman's naturally vigorous movements. In later part of the first stage and early second stage, inhalation anesthesia by mixing an equal part of oxygen and an anesthetic agent can be used. It may be used by any trained healthcare provider. The Journal of Maternal-Fetal & Neonatal Medicine. Appendix N: Algorithm for the Management of the Second Stage of Labor. Uterine contractions are checked. Maintenance of these skills requires staffing policies that support the development of a cadre of experienced delivery practitioners. Results from a retrospective cohort study. International health policy and programming have placed emphasis on the first stage of labor, including appropriate use of the partogram and identification of hypertension or sepsis, and have also focused on the third stage of labor with active management (AMTSL). Best Practice & Research Clinical Obstetrics & Gynaecology. The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. Prolonged labour may result in maternal exhaustion, fetal distress, and other complications including obstetric fistula. Advanced Second Stage Skills management of 2nd stage of labour. Management of Labour and Obstructed Labour Chapter 4 – ... since this time have led to the modification of time limits and management of second stage. Phases of second stage labor. SECOND STAGE OF LABOUR - RECOGNITION OF NORMAL PROGRESS AND MANAGEMENT OF DELAY This LOP is developed to guide clinical practice at the Royal Hospital for Women. NURS 235 : SESSION 4 - MANAGEMENT OF THE SECOND STAGE OF LABOUR University of Ghana Distance Education. As well as providing an attractive and humanistic setting, this approach has the potential to encourage greater utilization of health facilities and there is strong evidence that it reduces the need for medical interventions. Modifiers that affect the second stage length include factors such as parity, epidural anesthesia, delayed pushing, fetal station at complete dilation, maternal body mass index, fetal weight and occiput posterior (OP) position1. Postpartum haemorrhage is one of the leading causes of maternal death worldwide; it occurs in about 10.5% of births and accounts for over 130 000 maternal deaths annually.1 Active management of the third stage of labour is highly effective at preventing postpartum haemorrhage among facility-based deliveries. If you do not receive an email within 10 minutes, your email address may not be registered, Delivery facilities must offer every woman privacy and allow her to be accompanied by her choice of a supportive person (husband, friend, mother, relative, TBA); all women must be treated with respect. "Not all women feel the urge to push straight away in the second stage so it’s divided into passive and active stages (NICE, 2017) ." This review of second‐stage labor care practices discusses risk factors for perineal trauma and prolonged second stage and scrutinizes a variety of care practices including positions, styles of pushing, use of epidural analgesia, and perineal support techniques. During the 2nd stage of labor, perineal massage with lubricants and warm compresses may soften and stretch the perineum and thus reduce the rate of 3rd- and 4th-degree perineal tears . Author information: (1)National Maternity Hospital, Dublin, Ireland. In settings where only one skilled attendant is available, briefing of relatives, TBAs, or nonclinical staff about their roles is required. The third stage of labor refers to the period following the completed delivery of the newborn until the completed delivery of the placenta. Assess the fetal condition during the time the patient bears down. Second stage of labour; Third stage of labour; Internal podalic version and breech extraction; Complications; Video demonstration; Final assessments; User feedback; Submit. In the early part of labour, the patient may be allowed injectible analgesics, but these may cause depression of the baby and is best avoided if there are less than 3 hours before delivery. pace through the second stage of labour. Within UW Medicine, we hope to optimize second stage management and thereby improve overall vaginal delivery rates without increasing adverse maternal or neonatal outcomes. Further, according to Service Provision Assessments in several African countries (see www.measuredhs.com for survey reports), assisted vaginal delivery was notably lacking in service provision despite being a defined component of Basic Emergency Obstetric Care , . Extensive systematic review evidence is available regarding the relative merits of vacuum versus forceps delivery, therefore this will not be considered in detail in this guideline. In facilities that offer water births, adequate equipment should be provided for the protection and safety of the care provider, the woman, and her baby (i.e. The 2nd stage of labour begins when the cervix is fully dilated and ends when the fetus is fully expelled from the birth canal. Furthermore, a policy of routine episiotomy is more costly . A guide for midwives and doctors, Continuous support for women during childbirth, The disappearing art of instrumental delivery: time to reverse the trend, Reducing stillbirths: interventions during labour, Is vacuum extraction still known, taught and practiced? Aderhold KJ(1), Roberts JE. Both midwives and their medical colleagues have used this to base the management of the delivery of the baby according to a time regime. Best practice consists of antenatal identification of women with FGM and the offer of defibulation before the onset of labor, supported by appropriate counseling. In a systematic review of randomized controlled trials, active management of the third stage of labour was more effective than physiological management in preventing blood loss, severe postpartum … Continuously provide information, support, and encouragement to the woman and her companion. Here, birth planning needs to involve relatives, traditional birth attendants (TBAs), or nonclinical staff to assist in the role of “second birth attendant.” Such assistants need to be briefed about their role and arrangements made for them to be accessible and present for the birth. This is the stage in labor where the contribution of a qualified and skilled attendant with midwifery skills is the most critical in ensuring a safe outcome. There is no evidence that a policy of routine episiotomy resulted in significant reductions in laceration severity, pain, or pelvic organ prolapse compared with a policy of restricted use . To prevent perineal injuries. Epidemiology of unplanned out-of-hospital births attended by paramedics. As transfer to another facility during the second stage of labor is very problematic and is likely to be associated with poor outcomes because of the additional delay, every effort should be made to provide the assisted vaginal delivery component of Basic Emergency Obstetric Care so that delivery can be effected at health center level without the need for transfer. The principles of management of this stage are (a) to ensure birth of a healthy baby, (b) to prevent damage to the maternal tissues. You do not currently have access to this tutorial. Handheld vacuum devices such as the Kiwi OmniCup have become popular as these are easy to use, with the attendant able to control the suction. 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