Does extending time limits in the second stage of labour compromise maternal and neonatal outcomes?

Abstract

Background: Guidelines on intrapartum care may be based on outdated evidence that suggests that a prolonged second stage of labour is dangerous to both mother and baby. Aims: To examine the maternal and neonatal effects of extended second stage labour. Methods: Medical databases were searched, and a critical appraisal skills programme (CASP) tool used. This narrowed down the number of included studies to four, which were then critiqued. Findings: This literature review found that, as length of second stage increased, so did chance of spontaneous vaginal delivery. However, prolonged pushing was associated with slightly increased rates of chorioamnionitis and severe perineal trauma. Adverse outcomes were linked predominantly to the mothers but some minor neonatal effects were also noted. Conclusion: In alignment with the NMC Code, care plans should be formed in partnership with women and only after considering her individual circumstances and wishes. Health professionals should view guidelines as recommendations, rather than rules that must not be broken and instead consider the wider picture when dealing with extended second stage of labour.