How do midwives facilitate women to give birth during physiological second stage of labour? A review of the literature

Background: To be ‘with woman’ during childbirth is the privileged role of the midwife. The practice of individual midwives to facilitate women during physiological second stage of labour varies across local, national and... [ view full abstract ]

Background: To be ‘with woman’ during childbirth is the privileged role of the midwife. The practice of individual midwives to facilitate women during physiological second stage of labour varies across local, national and international birth settings. This has been identified from dialogue between, and observational experience of, international midwifery researchers. Some practices identified include for example: ‘hands on’ to ‘hands poised’; with one contraction the birth of the head immediately followed by the shoulders or birth of the head followed by awaiting a contraction for the shoulders; the birth of the anterior shoulder first or the posterior shoulder first. To optimise high quality midwifery care, it is imperative that practices based on the best available evidence are identified.

Method: Subsequently a team of midwifery researchers from Northern Ireland, The Netherlands and Sweden on WG2, of the EU Birth Research project (COST Action IS1405) undertook a systematic search of the literature to collate information relating to different practices and the available supporting evidence. Initially a scoping search was undertaken. Search terms, inclusion and exclusion criteria were then identified with use of Medical Subject Headings. Databases searched included: Medline, Embase, Cochrane, Cinahl, PsycINFO and MIDIRS. Titles, abstracts and full papers were screened for relevance and a quality review of the included studies undertaken.

Results: Initial searches highlighted over 8000 papers followed by search filters used to exclude animal studies and those not published in the English language. Hand searches of reference lists along with citation tracking were also undertaken to ensure comprehensive coverage of all relevant literature. The final review results will be presented at the conference.

Discussion: A midwife’s practice can be influenced by education and cultural practices but ultimately it should be informed by current research evidence. This review highlights the different practices utilised nationally and internationally and related evidence.

Conclusion This presentation will highlight the systematic literature review process, the results and recommendations for midwifery practice to facilitate physiological second stage of labour and further research.  Thus optimising high quality care and satisfying experience for women in labour.