Obstetric Gel Use to Shorten Labor and Prevent Lower Genital Tract Trauma: A Randomized Controlled Trial.

Background: According to WHO (2018) 8% of maternal deaths are caused by prolonged labor. The long duration of the second stage of labor is one of the factors that cause prolonged labor. For this reason, oral intake is recommended to meet the needs of the mother during labor. Giving glucose and honey as an oral alternative during labor was chosen because the time needed to become energy is relatively fast so that it can be given to mothers during labor and can provide oral intake for mothers in labor to accelerate the second stage and prevent prolonged labor.
 Purpose: To determine the effectiveness of giving glucose and honey solution on the duration of the second stage of labor in Midwife’s Independent Practice
 Methods: This research is a quantitative research using a quasi-experimental design research method. 30 respondents based on inclusion criteria were divided into two groups and intervened with a solution of glucose and honey. The duration of the second stage of labor was observed for each respondent and analyzed through the unpaired T-Test. Results: The results of the unpaired T statistic test obtained a p-value of 0.021 (p-value <0.05). There were differences in the duration of the second stage of labor in respondents who were given honey and glucose solution. The average duration of the second stage of labor in the treatment group that was given honey was 5.14 minutes shorter than the group given the glucose solution. Conclusion: There is a difference in the duration of the second stage of primigravida labor in pregnant women who are given honey and glucose solution. Giving honey is more effective in accelerating the duration of the second stage of labor in primigravida at PMB Palembang in 2021

Background: According to WHO (2018) 8% of maternal deaths are caused by prolonged labor. The long duration of the second stage of labor is one of the factors that cause prolonged labor. For this reason, oral intake is recommended to meet the needs of the mother during labor. Giving glucose and honey as an oral alternative during labor was chosen because the time needed to become energy is relatively fast so that it can be given to mothers during labor and can provide oral intake for mothers in labor to accelerate the second stage and prevent prolonged labor.
 Purpose: To determine the effectiveness of giving glucose and honey solution on the duration of the second stage of labor in Midwife’s Independent Practice
 Methods: This research is a quantitative research using a quasi-experimental design research method. 30 respondents based on inclusion criteria were divided into two groups and intervened with a solution of glucose and honey. The duration of the second stage of labor was observed for each respondent and analyzed through the unpaired T-Test. Results: The results of the unpaired T statistic test obtained a p-value of 0.021 (p-value <0.05). There were differences in the duration of the second stage of labor in respondents who were given honey and glucose solution. The average duration of the second stage of labor in the treatment group that was given honey was 5.14 minutes shorter than the group given the glucose solution. Conclusion: There is a difference in the duration of the second stage of primigravida labor in pregnant women who are given honey and glucose solution. Giving honey is more effective in accelerating the duration of the second stage of labor in primigravida at PMB Palembang in 2021

The objective of this study was to investigate the effects of obstetric gel application on the length of the first stage of labour and perineal trauma in primiparous women. This randomised controlled trial included 110 primiparous women. Women were randomly assigned to the two groups: lubricant gel group and control group. In the intervention group, during cervical dilatation of 4 cm until complete cervical dilatation, 5 ml of water-soluble lubricant gel was used at each vaginal examination. In the control group, routine care was performed. Mean duration of the total length (p = .025), the first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than control group. Perineal health was significantly better in the gel-applied pregnant women (p < .001). Using obstetric gel at the beginning of the first stage could shorten the total length, the first and the second stage of labour and could protect perineal health. IMPACT STATEMENT What is already known on this subject? Prolonged labour and perineal injuries are a major problem in natural childbirth for primiparous mothers. What the results of this study add? The first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than in the control group. Perineal health was significantly better in gel-applied pregnant women (p < .001). Using obstetric gel at the beginning of the first stage could shorten the total length, the first and the second stage of labour and could protect against perineal injury. What the implications are of these findings for clinical practice and/or further research? Obstetrical gel lubricant usage in the first stage of labour during the active phase of nulliparous women could shorten the total length, the first and the second stage of labour and could protect perineal health.

Background: second stage of labor begins when the cervix is fully dilated and ends with the birth of a baby. The duration of second stage of labor commonly lasts 2 hours for primigravida mothers and one hour for multigravida mothers. Prolonged labor is one of complications experienced by mothers in second stage of labor. Prolonged labor can cause several complications for both mothers and infants. Prolonged labor can harm both the mother and the infant. The harmful effects of complications during second stage of labor for mothers include the incidence of uterine atony, laceration, bleeding, infection, fatigue and shock and improving the birth rate with the C-section incision. Whereas the harmful effects of complications during second stage of labor for infants include asphyxiated, cerebral trauma caused by pressure on the head of the fetus, the injury due to action, and premature rupture of membranes. The severity of the injury increases continuously along with the longer of the duration of the labor process, and the risk of which rises quickly after 24 hours. The longer the labor, the higher the morbidity as well as the mortality. The stage of labor affected by all such factors mentioned is called the second stage of laborObjective: to find out the relationship of parity, maternal age, and birth weight with the duration of the second stage of labor.Methods: this study applied a quantitative research design using an analytical survey method through a cross sectional approach. The sample in this study was chosen using total sampling method with the purposive sampling technique, namely, that the sample was all maternity mothers who were coincidentally present at the time of the study at UPTD Karya Mukti Public Health Center in August 2021. Then, Chi-square statistical test was used to determine the relationship between independent variables and dependent variable.Results: of the 30 respondents, 20 respondents whose parity was not at risk (95.2%) experienced normal duration of second stage of labor, while 5 respondents (55.6%) whose parity was at risk experienced normal duration of second stage of labor. 21 respondents whose maternal age was not at risk (95.5%) experienced normal duration of second stage of labor, while 4 respondents whose maternal age was at risk (50%) experienced normal duration second stage of labor. 23 respondents (92%) with normal birth weight babies experienced normal duration of second stage of labor, while 2 respondents (40%)with large birth weight babies experienced normal duration of second stage of labor. The results of the Chi-square statistical test showed that there was a significant relationship between parity and the duration of the second stage of labor with the p-value of 0.019 £ 0.05 and the OR value of 9.157. There was a significant relationship between maternal age and the duration of the second stage of labor with the p-value of 0.011 £ 0.05 and the OR value of 5.387, and there was a significant relationship between birth weight and the duration of the second stage of labor with the p-value of 0.022 £ 0.05 and OR value of 3.405.Conclusions: there was a relationship between parity and the duration of second stage of labor. There was a relationship between maternal age and the duration of second stage of labor, and there was a relationship between birth weight and the duration of second stage of labor. Suggestions: It is hoped that health workers will further improve IEC (Information, Education, and Communication) regarding safe gestational age, safe parity and balanced nutrition as a form of antenatal care for pregnant women which is very influential, especially during the second stage of labor. In addition, for pregnant women, it is better to perform quality ANC to predict whether mothers will be likely to experience prolonged labor or not and also to prevent prolonged labor and other complications of pregnancy and labor. Then, based on the results of ANC tests, the mothers immediately referred to a more adequate hospitals/maternity hospitals to monitor the condition of their pregnancy so as to prevent the risk that will be faced by the mothers and fetus during labor. Keywords: Parity, Maternal Age, Birth Weight, Duration of Second Stage Labor

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

Background: Women with a prolonged second stage of labor are liable to develop spontaneous damage during childbirth and therefore they need special attention and care to shorten second stage of labor, protect the perineum and prevent neonatal trauma. Different interventions have been used to facilitate shortening the second stage of labor one of these methods may include the use of obstetric gel or virgin olive oil. Objectives: Identify the effect of using extra virgin olive oil versus obstetric gel during vaginal examination on the second stage of labor outcomes. Design: Experimental study. Setting: Labor and delivery unit of Maternity and Children hospital. Participants: A total sample of 40 primiparous women. The experimental group (20 primiparous) received virgin olive oil and 20 primiparous control group received hospital obstetric gel during vaginal examination. Methods: One tool was developed and used by the researcher for data collection namely: assessment tool which consisted of two parts; first part; socio demographic and obstetric data. The second part included assessment items related to first and second stage of labor outcomes. Results: A significant lower median duration of second stage of labor and crowning was observed for the experimental group compared to control group (30 min, 40min and 50 seconds, 60 seconds, respectively) P= <0.001 and P= 0.01 respectively. Consequently, the median total duration of labor for the experimental group was significantly shorter than the median duration in their counter parts, P=.04. Furthermore, the application of extra virgin olive oil has statistically significant protective effect regarding frequency of pain relief requirement. Conclusion: The application of olive oil had potential benefits of shortening the duration of second stage of labor and it decreases the frequency of requiring pain relief compared to application of routine obstetric gel with no harm done by the practice.

Objective: To study the correlation between the duration of labor and postpartum hemorrhage. Methods: The delivery data of singleton first-term pregnant women who delivered vaginally at Beijing Obstetrics and Gynecology Hospital from January 1, 2017 to December 31, 2017 were collected, 3 104 cases met inclusion criteria. According to the duration of the first labor (t), they were divided into two groups: t≥8 hours was the observation group, t<8 hours was the control group. In order to ensure the baseline characteristics of the subjects in the two groups were balanced, propensity score matching (PSM) was adopted, with matching ratio 1∶1. Then the observation group was divided into four subgroups: group 8-12 h, group 12-16 h, group 16-20 h, group ≥20 h. According to the presence or absence of labor intervention (oxytocin use, artificial rupture of membranes, labor analgesia), the observation group and control group were divided into non-labor intervention observation group, non-labor intervention control group, labor intervention observation group, and labor intervention control group. The case data of 3 104 subjects were analyzed and the duration of labor and atonic postpartum hemorrhage rate of each subgroup were compared with the control group. Results: The duration of the second stage of labor and the first+second stages of labor in the observation group (median:0.8, 13.3 hours) and its subgroups were both longer than those in the control group (median:0.6, 5.1 hours), with statistically significant differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group, group 16-20 h and group ≥20 h were higher than that in the control group [8.0%(124/1 552), 14.3%(41/287), 14.1%(12/85), 4.6%(72/1 552)], with significant statistical differences (all P<0.01). The duration of the second stage of labor and the first+second stages of labor in the observation group were both longer than those in the control group, regardless of the presence or absence of labor intervention, with statistically significant differences (all P<0.01). In both the observation group and the control group, the duration of the first stage of labor, the second stage of labor, and the first+second stages of labor with labor intervention were longer than those of the non-labor intervention, with significant statistical differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group with labor intervention [8.7%(110/1 263)] was higher than that in the observation group without labor intervention [4.8%(14/289)], with a statistical difference (P<0.05). Conclusions: With the increase of the duration of the first stage of labor, the rate of atonic postpartum hemorrhage increases. The first stage of labor is closely related to the second stage of labor, and to a certain extent the duration of the second stage of labor increases with the length of the first stage of labor. With the increase of the duration of the first stage of labor, the rate of labor intervention and atonic postpartum hemorrhage also increase, which could serve as a clinical warning that excessive labor intervention may indicate a higher incidence of atonic postpartum hemorrhage.

The duration of labor in spontaneous preterm deliveries: A retrospective observational study in a tertiary Irish maternity hospital

ABSTRACTBackground:The childbirth position has a significant influence on labor, maternal comfort, and neonatal outcome. In sitting position, there is a faster fetal descent with the effect of gravity. The information on this subject is relatively scant. Therefore, this study aimed to examine the effect of a supported sitting position during second stage of labor on its outcome in primigravidae.Materials and Methods:A quasi-experimental study with a post-test only control group design was used. 60 primigravidae were selected using total enumerative sampling. The labor outcome was assessed by self-structured maternal neonatal outcome checklist and socio-demographic proforma.Results:Statistically significant difference was observed on the mean duration of second stage of labor among primigravidae in control and experimental group (t = 5.87, P < 0.001) and also in the APGAR score of newborns (t = -3.98, P < 0.001). A statistical significant association of duration of second stage of labor with height and intensity of maternal work was also observed.Conclusions:A supported sitting position during labor was found to be effective in reducing duration of the second stage of labor. This can be used as a nursing intervention while providing care during labor especially at primary healthcare centers that can help in reducing the duration of second stage of labor.

Background: During the intrapartum period, a laboring mother experiences physiological stress due to contractions of the uterine muscles and skeletal muscles. Continuous contractions during the first stage of labor for 8 to 10 hours require adequate energy. Pain caused by these contractions often leads to a decreased appetite and fluid intake in laboring mothers, resulting in insufficient energy when entering the second stage of labor. This lack of energy can reduce the strength of uterine contractions, which may prolong the duration of the second stage of labor. Bananas are known as a source of carbohydrates and potassium that are easily available and can be given to laboring mothers as an energy reserve as well as to maintain electrolyte balance. Purpose: To determine the difference in the duration of the second stage of labor between laboring mothers who were given bananas during the first stage of labor and those who were not. Method: This study used a quasi-experimental design. The study population consisted of all laboring mothers at PMB Nurhidayah, located in Ketibung District, South Lampung Regency, in 2024. Samples were selected based on inclusion and exclusion criteria. A total of 40 respondents were included, consisting of 20 in the intervention group and 20 in the control group. The intervention group was given two bananas weighing a total of 400 grams during the first stage of labor. The duration of the second stage of labor was then measured in minutes. Data analysis was conducted using the Independent T-test. Results: There was no difference in the duration of the second stage of labor between mothers who were given bananas and those who were not, with a p-value&gt; 0.05. Conclusion: The administration of bananas during the first stage of labor did not affect the duration of the second stage of labor. Suggestion: Further research is needed to explore other benefits of bananas beyond their effect on the duration of the second stage of labor, such as fatigue levels and muscle strength.

We aimed to establish if epidural analgesia is associated with a higher incidence of operative vaginal delivery, longer duration of labor and more frequent use of oxytocin than labor without analgesia. We analyzed a cohort of 207 women with no risk factors who delivered with epidural analgesia in the labor unit of Spedali Civili, Brescia, Italy, during 2001. Length of the first and second stage of labor, mode of delivery, neonatal cord blood pH, neonatal Apgar score and neonatal outcomes were evaluated. Epidural analgesia was performed on request in 6%: in this group (group A) there were 141 (68%) nulliparae and 66 (32%) pluriparae; mean ( +/- standard deviation) gestational age at delivery was 39.4 +/- 1.3 weeks (range: 34.1-41.5 weeks). In this group, 184 (89%) had vaginal delivery and 23 (11%) delivered by Cesarean section. Among controls (group B), 368 (89%) had a vaginal delivery and 46 (11%) delivered by Cesarean section; vacuum extraction was used in 18 deliveries (9%) in group A and in 13 deliveries (3%) in group B. The duration of the second stage of spontaneous labor in the nulliparae of group A was significantly longer than in group B. No statistically significant differences were found between mean umbilical artery pH values of groups A and B. Our results confirm that epidural analgesia does not affect the rate of Cesarean delivery, while increasing the use of oxytocin augmentation, the duration of the second stage of labor and the rate of instrumental vaginal delivery.

Background: We aimed to establish if epidural analgesia is associated with a higher incidence of operative vaginal delivery, longer duration of labor and more frequent use of oxytocin than labor without analgesia. Methods: We analyzed a cohort of 207 women with no risk factors who delivered with epidural analgesia in the labor unit of Spedali Civili, Brescia, Italy, during 2001. Length of the first and second stage of labor, mode of delivery, neonatal cord blood pH, neonatal Apgar score and neonatal outcomes were evaluated. Results: Epidural analgesia was performed on request in 6%: in this group (group A) there were 141 (68%) nulliparae and 66 (32%) pluriparae; mean ( ± standard deviation) gestational age at delivery was 39.4 ± 1.3 weeks (range: 34.1-41.5 weeks). In this group, 184 (89%) had vaginal delivery and 23 (11%) delivered by Cesarean section. Among controls (group B), 368 (89%) had a vaginal delivery and 46 (11%) delivered by Cesarean section; vacuum extraction was used in 18 deliveries (9%) in group A and in 13 deliveries (3%) in group B. The duration of the second stage of spontaneous labor in the nulliparae of group A was significantly longer than in group B. No statistically significant differences were found between mean umbilical artery pH values of groups A and B. Conclusion: Our results confirm that epidural analgesia does not affect the rate of Cesarean delivery, while increasing the use of oxytocin augmentation, the duration of the second stage of labor and the rate of instrumental vaginal delivery.

BackgroundWe sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree).MethodsThis population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008–2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Main exposure was duration of second stage of labor, and main outcome was risks of severe perineal lacerations (third and fourth degree).ResultsRisk of severe perineal lacerations increased with duration of second stage of labor. Compared with a second stage of labor of 1 h or less, women with a second stage of more than 2 h had an increased risk (aOR 1.42; 95% CI 1.28–1.58). Compared with non-instrumental vaginal deliveries, the risk was elevated among instrumental vaginal deliveries (aOR 2.24; 95% CI 2.07–2.42). The risk of perineal laceration increased with duration of second stage of labor until less than 3 h in both instrumental and non-instrumental vaginal deliveries, but after 3 h, the ORs did not further increase. After adjustments for potential confounders, macrosomia (birth weight > 4 500 g) and occiput posterior fetal position were risk factors of severe perineal lacerations.ConclusionsThe risk of severe perineal laceration increases with duration until the third hour of second stage of labor. Instrumental delivery is the most significant risk factor for severe lacerations, followed by duration of second stage of labor, fetal size and occiput posterior fetal position.

Prolongation of active second stage of labor: Associated factors and perinatal outcomes

Objectives The purpose of this study was to evaluate the effect of using peanut balls during labor-on-labor memory, labor satisfaction, labor length, and neonatal APGAR scores. Methods This randomized, controlled, single-blind trial was conducted in 140 primiparous pregnant women (peanut ball group n = 70, control group n = 70) who delivered between January 2023 and March 2024. The study was conducted in the Obstetrics Clinic of a Medical Faculty Hospital in the Central Anatolian region of Turkey. Pregnant women in the peanut ball group were instructed to perform movements with the peanut ball after cervical dilation reached 5 cm. The control group received only standard intrapartum midwifery care. Data were collected by personal information form, labor and postpartum follow-up form (APGAR score, etc.), Birth Memory and Recall Scale, and Birth Satisfaction Scales. Results It was determined that the birth memory and recall memories of the pregnant women in the peanut ball group were more positive and their birth satisfaction was higher than the pregnant women in the control group (p < 0.001). The 1st minute APGAR scores (8.3 ± 0.6) and 5th minute APGAR scores (9.2 ± 0.7) of the newborns of the peanut ball group were higher than the 1st minute APGAR scores (7.8 ± 0.7) and 5th minute APGAR scores (8.5 ± 0.7) of the newborns of the control group (p < 0.001). The duration of the first stage (209.3 ± 38.6) and second stage (27.4 ± 13.7) of labor in the peanut ball group was shorter than the duration of the first stage (250.3 ± 54.6) and second stage (32.3 ± 11.3) of labor in the control group (p < 0.001, p = 0.021, respectively). Conclusion This study found that peanut ball application positively affected women’s labor memory and recall, and increased labor satisfaction. In addition, we found that peanut ball application increased neonatal APGAR scores and shortened the duration of the first and second stages of labor. Clinical trial registration www.clinicaltrials.gov (NCT06387680)