Objective:  The literature indicates that non-coached pushing during the second stage of labor may be beneficial to the mother and fetus.  Yet, most of the research is conducted on women with no epidural.  The most common practice at St. Luke’s Hospital, as well as elsewhere, is coached pushing, where the patient is told to push three times during each contraction, for ten seconds each.  We aimed to understand factors that influenced the use of non-coached pushing, which encourages the woman to listen to her body and push the way she wants, as well as determine if non-coached pushing for patients with an epidural is feasible.  We further examined the relationship between non-coached pushing and several outcome variables.

Design: This is a quasi-experimental research study using a convenience sample of laboring women.

Patients/Participants: Laboring women with singleton pregnancies who reached the pushing stage of labor.

Methods: Participants were classified as either “coached” or “non-coached.”  The influence of parity, use of pitocin, epidural, time spent laboring down, urge to push, and time spent pushing were initially examined via chi square analysis, and multivariate direct logistic regression was conducted to determine relationships with episiotomies, operative deliveries, perineal lacerations, and apgar scores.  Additionally, nurses were interviewed about why they used non-coached or coached pushing.

Implementation Strategies: Education was provided for nurses and doctors at seminars regarding the research behind the use of non-coached pushing, and its use was encouraged.

Results:  The use of non-coached pushing was related to multiparity, labor progression without the use of pitocin, labor without an epidural, an urge to push at 10cm, and a shorter time spent pushing (p<.05).  In bivariate relationships, non-coached pushing is related to a decrease in episiotomies, operative deliveries, and perineal lacerations (p<.05).  Multivariate logistic regression revealed a trend in the data suggesting that non-coached pushing is related to fewer 3^rd and 4^th degree lacerations, even when controlling for other factors (p<0.1).  In women with epidurals, multivariate logistic analysis revealed a significant relationship between coaching and operative deliveries (p<.05).  A common theme in the interviews with nurses was that women who were not pushing effectively were coached during their pushing.

Conclusion/Implications for nursing practice: Non-coached pushing during labor may have maternal benefits.  Though women without an epidural were more likely to receive non-coached pushing, over half of women with an epidural still had non-coached pushing.  This indicates that having an epidural is not prohibitive of non-coached pushing.

Keywords:

non-coached pushing, second stage of labor, epidural, perineal laceration