Sticky Situations in Second Stage

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Presented By: Samantha Sommerness, D.N.P., RN, CNM and Charles Hirt, M.D
September 2013

Delayed pushing in women with epidurals until the urge to push is present is an effective strategy to improve both maternal and neonatal outcomes for both nulliparous and parous women. The experience of a midwestern urban community hospital following implementation of an evidence based guideline compares outcomes of a retrospective group, guideline used and guideline not used group. Use of delayed pushing shows a 36% decrease in total pushing time, as well as a 50% reduction in the use of vacuum extractors resulting in a decrease in 3rd degree lacerations in those that utilized the guideline.


  • State the maternal and fetal evidenced based benefits of delaying pushing for nulliparous and parous women with epidural analgesia
  • Identify management strategies for enhancing fetal descent, while waiting for the urge to push in women with epidural analgesia
  • Identify why an evidenced based guideline used to standardize the management of the 2nd stage of labor in both the immediate and delayed pushing groups improve perinatal outcomes


Your entire healthcare team will benefit from this session so please be sure to tune in.


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