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Prolonged passive second stage of labour in nulliparous women: A multi perspective study
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0001-6823-9841
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Sustainable development
SDG 3: Ensure healthy lives and promote well-being for all at all ages, SDG 5: Achieve gender equality and empower all women and girls
Abstract [en]

Aim: This study aimed to describe the prolonged passive second stage of labour in nulliparous women in relation to its prevalence, risk factors, birth outcomes, midwives’ intrapartum management, and women's birth experiences. 

Methods: Study I was a qualitative study in which 36 midwives participated in seven focus group discussions. Data were analysed using qualitative content analysis. Studies II and III were retrospective observational cohort studies where medical records from 1131 nulliparous women in Sweden were reviewed. Analyses were performed using descriptive statistics and multivariable logistic regression. Study IV included 15 individual interviews with nulliparous women who had a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology.

Results: Midwives’ management of the passive phase is complex, especially if progress is slow. Guidelines were considered, but women were preferably managed individually. The prevalence of prolonged passive second stage (≥2h) was 38%. Epidural analgesia, malpresentation, maternal age ≥30 years, and birth weight of ≥4 kg were identified as risk factors for prolonged passive second stage. Longer duration of the passive second stage was associated with an increased risk of operative delivery. There were no associations with adverse maternal outcomes. Associations with adverse neonatal outcomes were found, although the rate of adverse neonatal outcomes were low in the study population. Women’s experiences of prolonged passive second stage were described in four themes: “An unknown phase”, “Trust and mistrust in the body’s ability”, ”Loss of control“, and “Support through presence and involvement”.

Conclusion: This thesis describes the prolonged passive second stage from multiple perspectives, including midwives, epidemiological data, and women’s experiences. The midwives’ management of the passive second stage included a complex continuous process of assessment and balancing options for the next step. A prolonged passive second stage was common and did not result in increased risks of adverse maternal outcomes, although further fetal surveillance can be called for. Nulliparous women experienced the passive second stage as an unknown phase and expected a different path for birth, and the experience could include loss of control and increased need for emotional and physical support. 

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2024. , p. 118
Series
Linnaeus University Dissertations ; 519
Keywords [en]
Birth experience, Childbirth, Labour stage, Second, Midwifery, Nulliparity, Prolonged labour
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-128381DOI: 10.15626/LUD.519.2024ISBN: 9789180821353 (print)ISBN: 9789180821360 (electronic)OAI: oai:DiVA.org:lnu-128381DiVA, id: diva2:1846202
Public defence
2024-04-12, Ikea-salen, Växjö, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-03-21 Created: 2024-03-21 Last updated: 2024-03-27Bibliographically approved
List of papers
1. Management of the passive phase of the second stage of labour in nulliparous women—Focus group discussions with Swedish midwives
Open this publication in new window or tab >>Management of the passive phase of the second stage of labour in nulliparous women—Focus group discussions with Swedish midwives
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 89-96Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-82810 (URN)10.1016/j.midw.2019.04.011 (DOI)000470962400015 ()31071586 (PubMedID)2-s2.0-85065088907 (Scopus ID)
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2024-03-21Bibliographically approved
2. Prolonged passive second stage of labor in nulliparous women-Prevalence and risk factors: A historical cohort study
Open this publication in new window or tab >>Prolonged passive second stage of labor in nulliparous women-Prevalence and risk factors: A historical cohort study
2022 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 101, no 5, p. 499-505Article in journal (Refereed) Published
Abstract [en]

Introduction This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. Material and Methods This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as >= 2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. Results The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90-5.34), malpresentation (aOR 2.26; 95% CI 1.27-4.05), maternal age >= 30 years (aOR 2.00; 95% CI 1.50-2.65) and birth weight >= 4 kg (aOR 1.50; 95% CI 1.05-2.15). Maternal body mass index >= 30 (aOR 0.52; 95% CI 0.34-0.79) and noncohabiting (aOR 0.51; 95% CI 0.30-0.89) reduced the odds of prolonged passive second stage. Conclusions A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age >= 30 years and birthweight >= 4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
labor stage, nullipara, passive, second stage, second stage labor duration
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-111108 (URN)10.1111/aogs.14342 (DOI)000769476000001 ()35293611 (PubMedID)2-s2.0-85126322826 (Scopus ID)
Available from: 2022-04-07 Created: 2022-04-07 Last updated: 2024-03-21Bibliographically approved
3. Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women
Open this publication in new window or tab >>Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women
2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 1, article id e0281183Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women.

Methods and findings: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120–239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience.

Conclusions: Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Place, publisher, year, edition, pages
Public Library of Science, 2023
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-117924 (URN)10.1371/journal.pone.0281183 (DOI)000945530400001 ()2-s2.0-85147175511 (Scopus ID)
Note

Forskningsprojektets diarienummer hos huvudman: 2020/4663-4.3.2.2

Available from: 2022-12-15 Created: 2022-12-15 Last updated: 2024-03-21Bibliographically approved
4. Nulliparous women’s lived experiences of prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology
Open this publication in new window or tab >>Nulliparous women’s lived experiences of prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction

Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women’s experiences of a prolonged passive second stage. 

Objective

To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women.MethodsA qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. 

Results

The analysis resulted in four themes: “An unknown phase” that entailed remaining in a phase that the women lacked an awareness of. “Trust and mistrust in the body’s ability” represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme “Loss of control” included experiences of frustration, fatigue, and having to deny bodily instincts. “Support through presence and involvement” signifies support through the midwife’s presence in the birthing room, although there were also descriptions of emotional or physical absence.

Conclusions

The findings contribute to the understanding of prolonged labour based on women’s lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

Keywords
Birth experience; Prolonged labour; Qualitative Research; Lived experience; Labour stage, Second
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-128382 (URN)
Projects
prolonged
Note

Manus

Available from: 2024-03-21 Created: 2024-03-21 Last updated: 2024-03-21

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