Effects of an Interdisciplinary Practice Bundle for Second-Stage Labor on Clinical Outcomes

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Nursing Science

Background:

• Renewed interest in second-stage labor practices due to evolving evidence challenging historical norms.
• Traditional interventions in the second stage of labor offer uncertain benefits for low-risk populations and may increase cesarean birth rates.

Purpose of the Study:

• To implement an interdisciplinary practice bundle for the second stage of labor.
• To promote safe birth outcomes, including method of birth and the overall birth experience.

Main Methods:

• Standardized, evidence-based recommendations for the second stage of labor were developed into a 5 Ps practice bundle.
• The bundle included patience, positioning, physiologic resuscitation, progress monitoring, and preventing urinary harm.
• Implementation occurred across 34 birthing hospitals within the Trinity Health system.

Main Results:

• Significant improvements in second-stage labor practices were observed, with spontaneous pushing increasing from 43% to 76%.
• The cesarean birth rate for nulliparous, term, singleton, vertex infants decreased significantly (p = 0.02).
• Maternal morbidity and negative newborn outcomes did not differ, while unexpected newborn complications decreased (p < 0.001), and birth satisfaction rose to the 81st percentile.

Conclusions:

• Implementation of 13 evidence-based practices for the second stage of labor successfully reduced primary cesarean births in low-risk nulliparous women.
• The initiative optimized maternal and fetal outcomes, supporting physiologic birth by minimizing routine interventions.
• Nurses play a key role in improving women's birth satisfaction and supporting evidence-based labor practices.