Díaz Estíbaliz Laderas, Rodriguez-Almagro Julián, Martinez-Galiano Juan Miguel, Rodríguez Rafael Picón, Hernández-Martínez Antonio
Department of Obstetrics & Gynecology, La Mancha Centro General Hospital, Av. Constitución, 3, Alcázar de San Juan, Ciudad Real, 13600, Spain.
Department of Nursing, Physiotherapy and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain.
BMC Nurs. 2024 Mar 26;23(1):202. doi: 10.1186/s12912-024-01863-7.
There are recommendations based on scientific evidence on care in the second stage of labor, but it is not known to what degree the professionals comply with these recommendations.
The aim of this study is to examine the variability in clinical practices among midwives during the second stage of labor, including positions, mobility, practices, and the maximum time allowed before initiating active pushing, and to assess their adherence to clinical practice guidelines.
A cross-sectional observational study. A self-designed questionnaire was developed and distributed online through scientific societies. The main variables studied were professional and work environment characteristics, maternal positions and mobility, practices during this stage, maximum time to start active pushing and duration of the second stage of labor. Descriptive statistics were calculated using SPSS 24.0.
Regarding the woman's position during childbirth, 80.3% (245) of midwives frequently or always allow the woman to choose her birthing position. Furthermore, 44.6% (136) of professionals prefer using side-lying positions for the mother. Regarding drinking fluids during childbirth, 51.1% (156) of midwives allowed the woman to drink the amount of liquids she wanted, whereas 11.1% (34) said that they would allow them to do so however, this was against the protocol of their hospital. When inquiring about the Kristeller maneuver, it was reported to be excessively performed in 35.1% (107) of cases for fetal bradycardia, 33.1% (101) for maternal exhaustion, and 38.4% (117) to avoid instrumental birth. Finally, a great variability was observed in the time criteria used for the initiation of active pushing and the maximum duration of the second stage of labor.
Certain practices, such as the Kristeller maneuver, are overused among midwives, with great variability in the use of certain procedures, the waiting times to initiate pushing and completion of the second stage of labor. Further training and awareness campaigns are needed for professionals to apply evidence-based care.
有基于科学证据的关于第二产程护理的建议，但尚不清楚专业人员在何种程度上遵守这些建议。
本研究的目的是检查助产士在第二产程中的临床实践差异，包括体位、活动情况、操作以及开始主动用力前允许的最长时间，并评估他们对临床实践指南的遵守情况。
一项横断面观察性研究。设计了一份自填式问卷，并通过科学协会在线分发。研究的主要变量包括专业和工作环境特征、产妇体位和活动情况、此阶段的操作、开始主动用力的最长时间以及第二产程的持续时间。使用SPSS 24.0进行描述性统计。
关于分娩时产妇的体位，80.3%（245名）助产士经常或总是允许产妇选择分娩体位。此外，44.6%（136名）专业人员更喜欢让母亲采用侧卧位。关于分娩时饮水，51.1%（156名）助产士允许产妇饮用她想要的液体量，而11.1%（34名）表示他们会允许，但这违反了他们医院的规程。在询问克里斯特勒手法时，据报告在35.1%（107例）的病例中因胎儿心动过缓过度使用，33.1%（101例）因产妇疲惫过度使用，38.4%（117例）为避免器械助产过度使用。最后，在开始主动用力的时间标准和第二产程的最长持续时间方面观察到很大差异。
某些操作，如克里斯特勒手法，在助产士中被过度使用，在某些程序的使用、开始用力的等待时间和第二产程的完成方面存在很大差异。需要对专业人员进行进一步培训并开展宣传活动，以应用循证护理。
