Lai Man-Lung, Lin Kuan-Chia, Li Hsin Yang, Shey Kuang-Shing, Gau Meei-Ling
Department of Nursing, Taipei Veterans General Hospital.
J Nurs Res. 2009 Mar;17(1):62-72. doi: 10.1097/JNR.0b013e3181999e78.
This article studied differences in postpartum fatigue and birth outcomes between women who pushed immediately and those who delayed pushing during the second stage of labor. Data were collected from primiparous women in their 38th to 42nd gestational week who did not receive epidural analgesia during labor and were free of complications during pregnancy. Using a quasi-experimental design, 72 participants selected by convenient sampling were assigned based on individual participant's preference to either an experimental or control group. For the experimental group, pushing was delayed until the point after full cervical dilation at which (a) the mother felt a strong physical pushing reflex, (b) the fetal head had both descended to at least the +1 level in the pelvis and turned to the occiput anterior position, and (c) uterine contractions were at least 30 mmHg. For the control group, the physician instructed mothers to begin pushing after full cervical dilation at the point when the fetal head was in the occiput anterior position and uterine contractions were at least 30 mmHg. The authors administered the Modified Fatigue Symptom Checklist at 1 and 24 hr after delivery to measure participant's fatigue levels. Birth outcomes were assessed based on medical chart data. Findings showed a significant difference between the two groups in terms of 1- and 24-hr postpartum fatigue scores. The duration of the second labor stage (experimental group, 70.31 +/- 37.17 min; control group, 129.06 +/- 75.69 min) also differed significantly. The group that pushed immediately recorded higher cesarean and instrument-assisted birth rates. No significant differences were observed in terms of perineal tears, maternal/neonatal complications, or neonatal Apgar scores. Results of this study provide important insights for caregivers working in the delivery room and suggest that current care procedures change to include the delayed pushing during the second stage of labor. By delaying pushing exertions until the mother feels a reflexive urge to do so, mothers' feelings of fatigue are significantly reduced.
本文研究了在第二产程中立即用力的女性与延迟用力的女性在产后疲劳和分娩结局方面的差异。数据收集自妊娠38至42周的初产妇，她们在分娩期间未接受硬膜外镇痛，且孕期无并发症。采用准实验设计，通过方便抽样选取72名参与者，根据个人偏好将其分为实验组或对照组。对于实验组，延迟用力直到宫颈完全扩张后，满足以下条件：(a)母亲感到强烈的身体用力反射；(b)胎儿头部至少下降到骨盆中的+1水平并转为枕前位；(c)子宫收缩至少为30 mmHg。对于对照组，医生指示母亲在宫颈完全扩张且胎儿头部为枕前位、子宫收缩至少为30 mmHg时开始用力。作者在产后1小时和24小时使用改良疲劳症状清单来测量参与者的疲劳水平。根据病历数据评估分娩结局。结果显示，两组在产后1小时和24小时的疲劳评分方面存在显著差异。第二产程的持续时间（实验组为70.31±37.17分钟；对照组为129.06±75.69分钟）也有显著差异。立即用力的组剖宫产和器械助产率更高。在会阴撕裂、母婴并发症或新生儿阿氏评分方面未观察到显著差异。本研究结果为产房护理人员提供了重要见解，并表明当前的护理程序应改变，包括在第二产程中延迟用力。通过将用力推迟到母亲感到反射性冲动时，母亲的疲劳感会显著降低。
