Associations between improved care during the second stage of labour and maternal and neonatal health outcomes in a rural hospital in Bangladesh. (November 2018)

• Record Type: Journal Article
• Authors: Pervin, Jesmin; Aktar, Shaki; Nu, U Tin; Rahman, Monjur; Rahman, Anisur
• Is Part Of: Midwifery. Volume 66(2018)
• Page Start: 30
• Page End: 35
• Publication Date: 2018-11
• Subjects: Second stage of labour -- Birthing position -- Spontaneous pushing -- Supports person -- Maternal and neonatal outcomes; SSL Second stage of labour -- HDSS Health and Demographic Surveillance System -- LMP Last menstrual period -- PPH Post-partum hemorrhage; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2018.07.010
• Languages: English
• ISSNs: 0266-6138

Abstract

Highlights: The present study is the initiation of care in second stage of labor with a package of interventions that included maintaining the birthing position according to women's choice, adopting a spontaneous pushing technique and using a support person during giving birth. The intervention package during the second stage of labor reduced the combined maternal and neonatal complications by 46%. A higher number of women adopted the birthing positions of their preferred choices and used spontaneous pushing techniques within a short period. Support persons were found more engaged in providing comfort measures to laboring women. Improved care during the second stage of labor may be a feasible and an efficient option to reduce the selected adverse maternal and neonatal health outcomes. Abstract: Objective: To evaluate the efficacy of care in the second stage of labour with a package of interventions that included (1) maintaining the birthing position according to the woman's choice, (2) adopting a spontaneous pushing technique and (3) using a support person, to reduce maternal and neonatal complications. Design: Used the data collected from two cohorts- before and after an initiative to improve care during the second stage of labour. Setting: A rural hospital in Bangladesh where 90–100 deliveries are conducted monthly and cesarean section provision is not available. Participants: One thousand and fifty-one singleton pregnancies who attended the hospital for giving birth in the first stage of labour before full dilatation of the cervix and with cephalic presentation. Measurements and findings: Data were collected through a structured checklist and questionnaire completed by research assistants; and also retrieved from hospital case record files, and the ongoing demographic surveillance system database. Coverage of adopting the upright or lateral position in the post-intervention period increased to 76% from about 1% in the pre-intervention period, and the spontaneous pushing technique increased to 97% from 77% in the same period. The odds of combined maternal and neonatal complications decreased by 46% between pre- and post-intervention periods (odds ratio: 0.54, 95% confidence interval: 0.43–0.70). Frequency of episiotomy (from 43% to 29%, P < 0.001), cervical tear (3.8% to 1.5%, P = 0.02), and median blood loss (200 ml to 150 ml; P < 0.001) were reduced significantly in the same period. No significant associations were observed in perineal tear or birth asphyxia occurrences. Key conclusions and implications for practice: The study suggests that there is a beneficial effect of care during the second stage of labour with a package of interventions in reducing maternal and neonatal complications, particularly in reducing the frequency of episiotomy, cervical tear, and blood loss during delivery. The preferred choice of posture during giving birth, adopting a spontaneous pushing technique and continuous presence of support person during the second stage of labour may be encouraged for better health outcomes.