Lin Yu-Ching, Gau Meei-Ling, Kao Ghi-Hwei, Lee Hung-Chang
MS, RN, CNM, Head Nurse, Department of Nursing, Hsinchu Mackay Memorial Hospital.
PhD, Assistant Professor, Department of Industrial and Commercial Design, Oriental Institute of Technology.
J Nurs Res. 2018 Dec;26(6):376-384. doi: 10.1097/jnr.0000000000000262.
The physical positions that are adopted by women during childbirth significantly impact their childbirth outcomes and experiences. Literature studies have associated using a squatting position with reduced childbirth pain and increased comfort and pushing efficiency. However, the major disadvantage of the squatting position is that women may lack the muscular fitness and stamina necessary to sustain this position for a long period.
The aim of this study was to compare the pushing experiences and birth outcomes of three different pushing positions during the second stage of labor.
A randomized controlled trial was conducted at a regional teaching hospital in northern Taiwan. Data were collected from 168 primiparous women during the 38th to 42nd gestational weeks. None of the participants received epidural analgesia during labor, and all were free of pregnancy and labor-related complications. During labor, after full cervical dilation and when the fetal head had descended to at least the +1 station and had turned to the occiput anterior position, the experimental group was asked to push in the squatting position while using the ergonomically designed ankle support. For purposes of comparison, Comparison Group A was asked to push in the squatting position without the use of the support, and Comparison Group B was asked to push in a standard semirecumbent position. All of the participants completed a demographic and obstetrics data sheet, the short-form McGill Pain Questionnaire, and the Labor Pushing Experience scale within 4 hours postpartum.
In terms of delivery time, the duration between the start of pushing to crowning for the experimental group (squatting with ankle supports) averaged 25.79 minutes less (F = 6.02, p < .05) than the time for Comparison Group B (semirecumbent). The duration between the start of pushing to infant birth averaged 25.21 minutes less for the experimental group than for Comparison Group B (F = 6.14, p < .05). Moreover, the experimental group had a lower average visual analog scale pain score (5.05 ± 3.22) than Comparison Group B (F = 42.67, p < .001), and the average McGill pain score for the experimental group was lower than both comparison groups (F = 18.12, p < .001). The participants in the group that delivered from a squatting position with ankle support had better labor pushing experiences than the comparison groups (F = 14.69, p < .001).
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: In comparison with both unsupported squatting and semirecumbent pushing, squatting with the aid of ergonomically designed ankle supports reduced pushing times, ameliorated labor pain, and improved the pushing experience. Thus, this intervention may reduce the caring needs of women during the second stage of labor. This intervention may be introduced in midwifery education programs and in clinical practice as a method to improve the care of women during the second stage of labor.
女性分娩时所采用的身体姿势会显著影响其分娩结局和体验。文献研究表明，采用蹲姿与减轻分娩疼痛、提高舒适度和推挤效率有关。然而，蹲姿的主要缺点是女性可能缺乏长时间维持该姿势所需的肌肉力量和耐力。
本研究旨在比较分娩第二阶段三种不同推挤姿势的推挤体验和分娩结局。
在台湾北部一家区域教学医院进行了一项随机对照试验。在孕38至42周期间收集了168名初产妇的数据。所有参与者在分娩期间均未接受硬膜外镇痛，且均无妊娠及与分娩相关的并发症。分娩过程中，在宫颈完全扩张且胎头至少下降至+1水平并转为枕前位后，实验组被要求使用符合人体工程学设计的脚踝支撑物以蹲姿进行推挤。为作比较，比较组A被要求在不使用支撑物的情况下以蹲姿进行推挤，比较组B被要求以标准半卧位进行推挤。所有参与者在产后4小时内完成了一份人口统计学和产科数据表、简短麦吉尔疼痛问卷以及分娩推挤体验量表。
在分娩时间方面，实验组（使用脚踝支撑物的蹲姿）从开始推挤到胎头露出的平均持续时间比比较组B（半卧位）短25.79分钟（F = 6.02，p <.05）。实验组从开始推挤到婴儿出生的平均持续时间比比较组B短25.21分钟（F = 6.14，p <.05）。此外，实验组的平均视觉模拟评分疼痛得分（5.05±3.22）低于比较组B（F = 42.67，p <.001），且实验组的平均麦吉尔疼痛评分低于两个比较组（F = 18.12，p <.001）。使用脚踝支撑物以蹲姿分娩的组中的参与者比比较组有更好的分娩推挤体验（F = 14.69，p <.001）。
结论/对实践的启示：与无支撑蹲姿和半卧位推挤相比，借助符合人体工程学设计的脚踝支撑物蹲姿可缩短推挤时间、减轻分娩疼痛并改善推挤体验。因此，这种干预措施可能会减少分娩第二阶段女性的护理需求。这种干预措施可引入助产士教育项目和临床实践中，作为改善分娩第二阶段女性护理的一种方法。
