Effects of Laboring Down

Effects of Laboring Down

The second stage of labor is defined as the time when a woman's cervix is completely dilated to the point the infant is delivered. In labor and delivery units, there are many techniques that nurses and providers use to instruct women through this phase of childbirth. In the past women have been instructed to push or bear down when their cervix was complete but new research has been developed that shows benefits to not pushing until the urge is felt by the mother .

The term 'laboring down' has been given to the process of not pushing until the urge is felt. The woman in labor will instruct the nurse when she feels the urge to push. The urge to push is known as Ferguson's reflex (Doyle, 2011). Ferguson's reflex occurs when the baby's head gets low into the birth canal and stretches the pelvic nerves (Doyle, 2011). The pressure on the pelvic floor and the stretching of the pelvic nerves gives the woman a natural urge to push and it increases the effectiveness of the pushing being done.

In labor and delivery at the hospital this practice of laboring down is becoming more common. Providers are instructing women on the positive effects that laboring down has on their bodies and for their babies. Women who are delivering their first babies can be completely dilated and not push for up to two hours without an epidural and up to three hours with an epidural. Women who have already had one vaginal delivery are able to labor down for one hour without an epidural and up to two hours with an epidural. These guidelines are different at every facility. If the laboring mother has labored down for a sufficient amount of time and still is not feeling the urge to push the nurse would then instruct her to push to see if she is able to move the baby down in the birth canal. At this point it would be determined if the infant would be able to be delivered vaginally or if the mother would need a cesarean birth.

The significance of laboring down for the nurse that is caring for the woman is that she must take an inactive role in her interventions. This means the nurse allows the patient to tell when it is time to push instead of instructing the woman to push. It is also the nurse's responsibility to assess the patient for pain and fatigue. The nurse should also be monitoring the infant for variations in the fetal heart rate. This is done by external or internal monitors that graph heart tones and shows if the infant is having decelerations. The decelerations indicate if the infant is tolerating labor .

There has been a lot of research done to support laboring down. Studies show that it benefits the mother and the infant. Comparative studies have been completed by many different researchers to determine if laboring down or active pushing is better. Nursing journals and healthcare facilities have reports on studies that entail the benefits of this new evidence based practice .

A randomized controlled clinical study was done by Susan Hansen, Steven Clark, and Joyce Foster (date) that discussed the difference between women who actively pushed or had a passive fetal decent in the second stage of labor. A passive fetal descent means that the patients were instructed to labor down until they felt the urge to push. A prospective random sample was chosen of two hundred fifty two women who were thirty seven to forty two weeks gestation. They were pregnant with one child and had no known fetal anomalies. The women also had epidurals prior to being completely dilated. Many variables were measured in this trial. They include the rate of fetal descent, length of time pushing, the number and type of fetal heart rate decelerations, Apgar scores, arterial cord pH values, perineal injuries, type of delivery, length of second stage, maternal fatigue, and endometritis (Hansen, Clark, & Foster, 2002).

The women were broken into two groups in which one actively pushed and the other used the process of laboring down. A nurse was continuously monitoring fetal heart tones for variables and the study addressed fatigue