The Ottawa Hospital’s Clinical Practice Guidelinefor the Second Stage of Labour

Abstract

The management of the second stage of labour remainscontroversial, and there are very few comprehensiveevidence-based clinical practice guidelines to assist careproviders. We describe an approach to developing a local clinicalpractice guideline that included extensive review of the literature;use of a guideline appraisal instrument to assess methodologicalrigour, content, clarity and applicability; use of a recommendationmatrix; drafting a local guideline; obtaining formal feedback;making revisions; and designing an implementation and evaluationplan.Recommendations from this guideline include timelines for thetotal length of second stage, waiting time, and pushing time.Positioning of the woman, use of oxytocin, and fetal assessmentare also discussed. This guideline is not intended to be used forwomen with multiple gestation and women attempting vaginal birthafter Caesarean (VBAC) or in clinical situations where littleevidence on best practice exists and management isindividualized. We advocate an approach to the second stage oflabour that enhances patient safety through team planning,communication, and documentation.