The Effects of Delayed Pushing During the Second Stage of Labor on Postpartum Fatigue and Labor Results
Yıl 2021,
Cilt: 5 Sayı: 3, 546 - 560, 30.09.2021
Özlem Demirel Bozkurt
,
Oya Kavlak
,
Sevgi Özkan
,
Ahsen Şirin
Öz
Objective: The study was made to examine the effects of delayed pushing during the second stage of labor and pushing on postpartum fatigue and labor results.
Method: This is a randomized controlled experimental study. The sampling of the research is comprised of 48 primiparous women (23 in the delayed pushing group and 25 in the control group). The pushing of control group was initiated when strong uterine contraction appeared when the fetal head rotation was completed. Different from the control group, when the fetal head was “+1” inside the pelvis, considering the desire to push, pregnant were asked to delay the pushing until the feeling of powerful and involuntary pushing reflex in the delayed pushing group. As a data collection tool, “Pregnant Identification Form”, “Follow-up Form”, “Partograph” and, “Visual Analogue Scale for Fatigue” was used.
Results: The mean duration of the second stage of labor was 38.34 ± 17.84 minutes in the delayed pushing group and 13.52 ± 5.29 minutes in the control group. It was observed that a statistically significant difference was found between the delayed pushing and control group women in terms of the mean duration of the second stage of labor, the mean pushing time, the average fatigue, and energy scores in the first hour after labor (p <0.05).
Conclusion: It was found out that delayed pushing prolonged the time of the second stage of labor but reduced the pushing time and significantly affected the fatigue at the first one hour of postpartum.
Destekleyen Kurum
Ege Üniversitesi Bilimsel Araştırma Projesi (BAP)
Proje Numarası
11/ASYO/007
Teşekkür
We would like to thank Ege University Rectorate within the scope of Scientific Research Projects (BAP number: 11- ASYO- 007), the pregnant women who participated in the research, and the esteemed faculty members involved in the thesis monitoring and evaluation jury.
Kaynakça
- 1. FIGO Safe Motherhood and Newborn Health (SMNH) Committee. (2012). Management of the second stage of labor. International Journal of Gynecology and Obstetrics, 119, 111-116. doi: 10.1016/j.ijgo.2012.08.002
- 2. Güngör, İ., & Yıldırım-Rathfisch, G. (2009). Normal doğum eyleminin ikinci ve üçüncü evresinde kanıta dayalı uygulamalar (Evidence based practices in the second and third stage of normal labor). HEMAR-G, 11(2), 56-65.
- 3. Lai, M. L., Lin, K. C., Li, H. Y., Shey, K. S., & Gau, M. L. (2009). Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women. J Nurs Res., 17(1), 62-71.
- 4. World Health Organization (WHO). (2018). World Health Organization recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO.
- 5. Sperling, J. D., & Gossett, D. R. (2019). Immediate versus delayed pushing during the second stage of labor. Obstetric Anesthesia Digest, 39(3), 116-118.
- 6. Infante-Torres, N., Molina-Alarcón, M., Arias-Arias, A., Rodríguez-Almagro, J., & Hernández-Martínez, A. (2020). Relationship between prolonged second stage of labor and short-term
neonatal morbidity: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(21), 7762 (1-26).
- 7. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü (HÜNEE). (2019). 2018 Türkiye Nüfus ve Sağlık Araştırması (2018 Turkey Demographic and Health Surveys). Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye.
- 8. Yee, L. M., Sandoval, G., Bailit, J., Reddy, U. M., Wapner, R. J., Varner, M.W., & et al. (2016). Maternal and neonatal outcomes with early compared with delayed pushing among nulliparous women. Obstet Gynecol, 128(5), 1039-1047.
- 9. Sandström, A., Altman, M., Cnattingius, S., Johansson, S., Ahlberg, M., & Stephansson, O. (2017). Durations of second stage of labor and pushing, and adverse neonatal outcomes: A population-based cohort study. J Perinatol, 37(3), 236-242.
- 10. Cahill, A. G., Srinivas, S. K., Tita, A. T., Caughey, A. B., Richter, H. E., Gregory, W. T., & et al. (2018). Effect of immediate vs delayed pushing on rates of spontaneous vaginal delivery among nulliparous women receiving neuraxial analgesia: A randomized clinical trial. JAMA, 320(14), 1444-1454.
- 11. Di Mascio, D., Saccone, G., Bellussi, F., Al-Kouatly, H. B., Brunelli, R., Panici, P. B., & et al. (2020). Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: A systematic review and meta-analysis of randomized controlled trials. AM J Obstet Gynecol, 23(2), 189-203. doi:10.1016/j.ajog.2020.02.002
- 12. Szu, L. T., Chou, P. Y., Lin, P. H., Chen, C., Lin, W. L., & Chen, K. H. (2020). Comparison of maternal and fetal outcomes between delayed and immediate pushing in the second stage of vaginal delivery: Systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet, 1-19.
- 13. Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., & et al. (2010). CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ, 340(mar23 1):c869–c869.
- 14. Orji, E. (2008). Evaluating progress of labor in nulliparas and multiparas using the modified WHO Partograph. International Journal of Gynecology and Obstetrics, 102, 249–252.
- 15. Lee, K. A., & Zaffke, M. (1999). Longitudinal changes in fatigue and energy during pregnancy and the postpartum period. JOGNN, 28(2), 183-191.
- 16. Yurtsever, S. (2000). Kronik hastalıklarda yorgunluk ve hemşirelik bakımı (The fatigue in chronic illnesses and nursing care). Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi,
4(1):16-20.
- 17. Yildirim, G., & Beji, N. K. (2008). Effects of pushing techniques in birth on mother and fetus: A randomized study. Birth, 35(1), 25-30.
- 18. Kömürcü, N., & Ergin, A. B. (2008). Doğum ağrısı ve yönetimi (Labor pain and management). Bedray Basın Yayıncılık, İstanbul.
- 19. Turan, A., & Yilmaz, T. (2019). Doğumun ikinci evresinin süresi, uzaması ve yönetimi (Duration, prolongation and management of second stage of birth). Bandırma Onyedi Eylül Üniversitesi
Sağlık Bilimleri ve Araştırmaları Dergisi, 1(2), 102-119.
- 20. Saydam, B. K. (2008). Doğum Eylemi (Birth Labor). Kadın Sağlığı Kitabı. Editör: Şirin A. Bedray Basın Yayıncılık. İstanbul, 646-662.
- 21. Li W., Zhang H., Ling Y., & Jin S. (2011). Effect of prolonged second stage of labor on maternal and neonatal outcomes. Asian Pac J Trop Med, 409-411.
- 22. Simpson, K. R., & James, D. C. (2005). Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: A randomized clinical trial. Nurs Res, 54(3), 149–157.
- 23. Gillesby, E., Burns, S., Dempsey, A., Kirby, S., Mogensen, K., Naylor K., & et al. (2010). Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women
with epidural anesthesia. JOGNN, 39, 635-644.
- 24. Kelly, M., Johnson, E., Lee, V., Massey, L., Purser, D., Ring, K., & et al. (2010). Delayed versus immediate pushing in second stage of labor. MCN-AM J Matern-Chil, 35(2), 81-88.
- 25. Alp, N., & Mete, S. (2008). Postpartum yorgunluk düzeyi ile uyku ve beslenmenin yorgunluğa etkisi (Postpartum fatigue level with the effect of sleep and nutrition on the fatigue). Anadolu
Hemşirelik ve Sağlık Bilimleri Dergisi, 11(4), 10-18.
- 26. Başar, F., & Hürata, S. Ş. (2018). The effect of pushing techniques on duration of the second labor stage, mother and fetus: A randomized controlled trial. International Journal of Health
Services Research and Policy, 3(3), 123-134.
- 27. Hsieh, C. H., Chen, C. L., Han, T. J., Lin, P. J., & Chiu, H. C. (2018). Factors influencing postpartum fatigue in vaginal-birth women: Testing a path model. J Nurs Res, 26(5), 332-339. doi:
10.1097/jnr.0000000000000249
- 28. American College of Obstetricians and Gynecologists (ACOG). (2019). Committee opinion no. 766: Approaches to limit intervention during labor and birth. Obstet Gynecol, 133(2), e164–
73.
- 29. Akyıldız, D., Çoban, A., Gör Uslu, F., & Taşpınar, A. (2021). Effects of obstetric interventions during labor on birth process and newborn health. Florence Nightingale J Nurs, 29(1), 9-21.
- 30. Vaziri, F., Arzhe, A., Asadi, N., Pourahmad, S., & Moshfeghy, Z. (2016). Spontaneous pushing in lateral position versus valsalva maneuver during second stage of labor on maternal and fetal
outcomes: A randomized clinical trial. Iran Red Crescent Me, 18(10), e29279. doi: 10.5812/ircmj.29279
- 31. Ahmadi, Z., Torkzahrani, S., Roosta, F., Shakeri, N., & Mhmoodi, Z. (2017). Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: A
randomized clinical trial. Iranian journal of nursing and midwifery research, 22(1), 62.
- 32. Hassan, H. E., Gamel, W. M. A., & Genedy, A. S. E. (2021). Spontaneous versus directed pushing technique: maternal and neonatal outcomes: A comparative study in northern upper Egypt.
Int J Nurs Stud, 6(1), 24.
- 33. Myles, T. D., & Santolaya, J. (2003). Maternal and neonatal outcomes in patients with a prolonged second stage of labor. Obstet Gynecol, 102(1), 52-58.
- 34. Chang, S. C., Chou, M. M., Lin, K. C., Lin, L. C., Lin, Y. L., & Kuo, S. C. (2011). Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the
second stage of labour. Midwifery, 27(6), 825-831. doi:10.1016/j.midw.2010.08.009
- 35. Koyucu, R. G., & Demirci, N. (2017). Effects of pushing techniques during the second stage of labor: A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology, 56(5),
606-612.
Doğumun İkinci Evresinde Ertelenmiş Ikınmanın Postpartum Yorgunluk ve Doğum Sonuçlarına Etkisi
Yıl 2021,
Cilt: 5 Sayı: 3, 546 - 560, 30.09.2021
Özlem Demirel Bozkurt
,
Oya Kavlak
,
Sevgi Özkan
,
Ahsen Şirin
Öz
Amaç: Araştırma, doğumun ikinci evresinde ertelenmiş ıkınmanın postpartum yorgunluk ve doğum sonuçlarına etkisini incelemek amacıyla yapılmıştır.
Yöntem: Randomize kontrollü deneysel olarak gerçekleştirilen araştırmanın örneklemini 48 primipar gebe (ertelenmiş ıkınma grubu n:23, kontrol grubu n:25) oluşturmuştur. Kontrol grubunda ıkınma, güçlü uterus kontraksiyonları oluştuğunda, fetal baş rotasyonunu tamamladığında başlamıştır. Ertelenmiş ıkınma grubunda kontrol grubundan farklı olarak, fetal baş pelvis içinde “+1” düzeyinde olduğunda ve kadında ıkınma isteğinin olması dikkate alınarak, güçlü ve istemsiz fiziksel itme refleksi hissedene kadar ıkınmanın ertelenmesi istenmiştir. Veri toplamada, “Gebe Tanılama Formu”, “İzlem Formu”, “Partograf” ve “Yorgunluk İçin Görsel Benzerlik Skalası” kullanılmıştır.
Bulgular: İkinci evrenin süre ortalaması ertelenmiş ıkınma grubunda 38.34±17.84 dk, kontrol grubunda 13.52±5.29 dakikadır. Ertelenmiş ıkınma ve kontrol grubu kadınların; doğumun ikinci evresinin süre ortalamaları, ıkınma süre ortalamaları, doğum sonrası ilk bir saatteki yorgunluk ve enerji puan ortalamaları arasında istatistiksel olarak anlamlı fark saptanmıştır (p<0.05).
Sonuç: Ertelenmiş ıkınmanın doğumun ikinci evresinin süresini uzattığı, ıkınma süresini azalttığı ve doğum sonrası ilk bir saatteki yorgunluğu anlamlı olarak azalttığı bulunmuştur.
Proje Numarası
11/ASYO/007
Kaynakça
- 1. FIGO Safe Motherhood and Newborn Health (SMNH) Committee. (2012). Management of the second stage of labor. International Journal of Gynecology and Obstetrics, 119, 111-116. doi: 10.1016/j.ijgo.2012.08.002
- 2. Güngör, İ., & Yıldırım-Rathfisch, G. (2009). Normal doğum eyleminin ikinci ve üçüncü evresinde kanıta dayalı uygulamalar (Evidence based practices in the second and third stage of normal labor). HEMAR-G, 11(2), 56-65.
- 3. Lai, M. L., Lin, K. C., Li, H. Y., Shey, K. S., & Gau, M. L. (2009). Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women. J Nurs Res., 17(1), 62-71.
- 4. World Health Organization (WHO). (2018). World Health Organization recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO.
- 5. Sperling, J. D., & Gossett, D. R. (2019). Immediate versus delayed pushing during the second stage of labor. Obstetric Anesthesia Digest, 39(3), 116-118.
- 6. Infante-Torres, N., Molina-Alarcón, M., Arias-Arias, A., Rodríguez-Almagro, J., & Hernández-Martínez, A. (2020). Relationship between prolonged second stage of labor and short-term
neonatal morbidity: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(21), 7762 (1-26).
- 7. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü (HÜNEE). (2019). 2018 Türkiye Nüfus ve Sağlık Araştırması (2018 Turkey Demographic and Health Surveys). Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, T.C. Cumhurbaşkanlığı Strateji ve Bütçe Başkanlığı ve TÜBİTAK, Ankara, Türkiye.
- 8. Yee, L. M., Sandoval, G., Bailit, J., Reddy, U. M., Wapner, R. J., Varner, M.W., & et al. (2016). Maternal and neonatal outcomes with early compared with delayed pushing among nulliparous women. Obstet Gynecol, 128(5), 1039-1047.
- 9. Sandström, A., Altman, M., Cnattingius, S., Johansson, S., Ahlberg, M., & Stephansson, O. (2017). Durations of second stage of labor and pushing, and adverse neonatal outcomes: A population-based cohort study. J Perinatol, 37(3), 236-242.
- 10. Cahill, A. G., Srinivas, S. K., Tita, A. T., Caughey, A. B., Richter, H. E., Gregory, W. T., & et al. (2018). Effect of immediate vs delayed pushing on rates of spontaneous vaginal delivery among nulliparous women receiving neuraxial analgesia: A randomized clinical trial. JAMA, 320(14), 1444-1454.
- 11. Di Mascio, D., Saccone, G., Bellussi, F., Al-Kouatly, H. B., Brunelli, R., Panici, P. B., & et al. (2020). Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: A systematic review and meta-analysis of randomized controlled trials. AM J Obstet Gynecol, 23(2), 189-203. doi:10.1016/j.ajog.2020.02.002
- 12. Szu, L. T., Chou, P. Y., Lin, P. H., Chen, C., Lin, W. L., & Chen, K. H. (2020). Comparison of maternal and fetal outcomes between delayed and immediate pushing in the second stage of vaginal delivery: Systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet, 1-19.
- 13. Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., & et al. (2010). CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ, 340(mar23 1):c869–c869.
- 14. Orji, E. (2008). Evaluating progress of labor in nulliparas and multiparas using the modified WHO Partograph. International Journal of Gynecology and Obstetrics, 102, 249–252.
- 15. Lee, K. A., & Zaffke, M. (1999). Longitudinal changes in fatigue and energy during pregnancy and the postpartum period. JOGNN, 28(2), 183-191.
- 16. Yurtsever, S. (2000). Kronik hastalıklarda yorgunluk ve hemşirelik bakımı (The fatigue in chronic illnesses and nursing care). Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi,
4(1):16-20.
- 17. Yildirim, G., & Beji, N. K. (2008). Effects of pushing techniques in birth on mother and fetus: A randomized study. Birth, 35(1), 25-30.
- 18. Kömürcü, N., & Ergin, A. B. (2008). Doğum ağrısı ve yönetimi (Labor pain and management). Bedray Basın Yayıncılık, İstanbul.
- 19. Turan, A., & Yilmaz, T. (2019). Doğumun ikinci evresinin süresi, uzaması ve yönetimi (Duration, prolongation and management of second stage of birth). Bandırma Onyedi Eylül Üniversitesi
Sağlık Bilimleri ve Araştırmaları Dergisi, 1(2), 102-119.
- 20. Saydam, B. K. (2008). Doğum Eylemi (Birth Labor). Kadın Sağlığı Kitabı. Editör: Şirin A. Bedray Basın Yayıncılık. İstanbul, 646-662.
- 21. Li W., Zhang H., Ling Y., & Jin S. (2011). Effect of prolonged second stage of labor on maternal and neonatal outcomes. Asian Pac J Trop Med, 409-411.
- 22. Simpson, K. R., & James, D. C. (2005). Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: A randomized clinical trial. Nurs Res, 54(3), 149–157.
- 23. Gillesby, E., Burns, S., Dempsey, A., Kirby, S., Mogensen, K., Naylor K., & et al. (2010). Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women
with epidural anesthesia. JOGNN, 39, 635-644.
- 24. Kelly, M., Johnson, E., Lee, V., Massey, L., Purser, D., Ring, K., & et al. (2010). Delayed versus immediate pushing in second stage of labor. MCN-AM J Matern-Chil, 35(2), 81-88.
- 25. Alp, N., & Mete, S. (2008). Postpartum yorgunluk düzeyi ile uyku ve beslenmenin yorgunluğa etkisi (Postpartum fatigue level with the effect of sleep and nutrition on the fatigue). Anadolu
Hemşirelik ve Sağlık Bilimleri Dergisi, 11(4), 10-18.
- 26. Başar, F., & Hürata, S. Ş. (2018). The effect of pushing techniques on duration of the second labor stage, mother and fetus: A randomized controlled trial. International Journal of Health
Services Research and Policy, 3(3), 123-134.
- 27. Hsieh, C. H., Chen, C. L., Han, T. J., Lin, P. J., & Chiu, H. C. (2018). Factors influencing postpartum fatigue in vaginal-birth women: Testing a path model. J Nurs Res, 26(5), 332-339. doi:
10.1097/jnr.0000000000000249
- 28. American College of Obstetricians and Gynecologists (ACOG). (2019). Committee opinion no. 766: Approaches to limit intervention during labor and birth. Obstet Gynecol, 133(2), e164–
73.
- 29. Akyıldız, D., Çoban, A., Gör Uslu, F., & Taşpınar, A. (2021). Effects of obstetric interventions during labor on birth process and newborn health. Florence Nightingale J Nurs, 29(1), 9-21.
- 30. Vaziri, F., Arzhe, A., Asadi, N., Pourahmad, S., & Moshfeghy, Z. (2016). Spontaneous pushing in lateral position versus valsalva maneuver during second stage of labor on maternal and fetal
outcomes: A randomized clinical trial. Iran Red Crescent Me, 18(10), e29279. doi: 10.5812/ircmj.29279
- 31. Ahmadi, Z., Torkzahrani, S., Roosta, F., Shakeri, N., & Mhmoodi, Z. (2017). Effect of breathing technique of blowing on the extent of damage to the perineum at the moment of delivery: A
randomized clinical trial. Iranian journal of nursing and midwifery research, 22(1), 62.
- 32. Hassan, H. E., Gamel, W. M. A., & Genedy, A. S. E. (2021). Spontaneous versus directed pushing technique: maternal and neonatal outcomes: A comparative study in northern upper Egypt.
Int J Nurs Stud, 6(1), 24.
- 33. Myles, T. D., & Santolaya, J. (2003). Maternal and neonatal outcomes in patients with a prolonged second stage of labor. Obstet Gynecol, 102(1), 52-58.
- 34. Chang, S. C., Chou, M. M., Lin, K. C., Lin, L. C., Lin, Y. L., & Kuo, S. C. (2011). Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the
second stage of labour. Midwifery, 27(6), 825-831. doi:10.1016/j.midw.2010.08.009
- 35. Koyucu, R. G., & Demirci, N. (2017). Effects of pushing techniques during the second stage of labor: A randomized controlled trial. Taiwanese Journal of Obstetrics and Gynecology, 56(5),
606-612.