A Quality Improvement Project Utilizing a Clinical Practice Guideline in Women During Second-Stage Labor

Area of Science:

• Obstetrics and Gynecology
• Nursing Science
• Clinical Practice Guidelines

Background:

• Second-stage labor presents significant challenges for birthing individuals, demanding increased physical exertion.
• Variations in nursing interventions during this critical phase can impact labor and birth outcomes.
• A notable disparity exists in the nursing care provided during the second stage of labor.

Purpose of the Study:

• To evaluate the impact of a clinical practice guideline on second-stage labor management.
• To assess the guideline's effects on birth method, including spontaneous vaginal birth, operative vaginal birth, and vaginal birth after cesarean.
• To determine the guideline's influence on perineal trauma and associated interventions.

Main Methods:

• Implementation and evaluation of a standardized clinical practice guideline for second-stage labor.
• Focus on key elements: maternal positioning, timing of pushing, and type of pushing effort.
• Data collection on birth method, episiotomy rates, lacerations, and need for suturing.

Main Results:

• Significant increase in spontaneous vaginal births.
• Reduction in vacuum-assisted births.
• Doubled rate of vaginal births after cesarean (VBAC).
• Decreased rates of episiotomy and various types of perineal lacerations.
• Reduced need for suturing of birth-acquired lacerations.

Conclusions:

• Adherence to a clinical practice guideline positively influences second-stage labor management.
• The guideline effectively improved birth method outcomes and reduced perineal trauma.
• Standardized nursing interventions in second-stage labor can lead to better maternal and neonatal outcomes.