The Ottawa Hospital's Clinical Practice Guideline for the Second Stage of Labour.
The management of the second stage of labour remains controversial, and there are very few comprehensive evidence-based clinical practice guidelines to assist care providers. We describe an approach to developing a local clinical practice guideline that included extensive review of the literature; use of a guideline appraisal instrument to assess methodological rigour, content, clarity and applicability; use of a recommendation matrix; drafting a local guideline; obtaining formal feedback; making revisions; and designing an implementation and evaluation plan. Recommendations from this guideline include timelines for the total length of second stage, waiting time, and pushing time. Positioning of the woman, use of oxytocin, and fetal assessment are also discussed. This guideline is not intended to be used for women with multiple gestation and women attempting vaginal birth after Caesarean (VBAC) or in clinical situations where little evidence on best practice exists and management is individualized. We advocate an approach to the second stage of labour that enhances patient safety through team planning, communication, and documentation.
Sprague
Ann E
AE
Perinatal Partnership Program of Eastern and Southeastern Ontario, Ottawa ON.
Oppenheimer
Lawrence
L
Department of Obstetrics and Gynecology and the Maternal/Newborn Program, The Ottawa Hospital, Ottawa ON.
McCabe
Linda
L
Department of Obstetrics and Gynecology and the Maternal/Newborn Program, The Ottawa Hospital, Ottawa ON.
Brownlee
Janet
J
Department of Obstetrics and Gynecology and the Maternal/Newborn Program, The Ottawa Hospital, Ottawa ON.
Graham
Ian D
ID
Faculty of Nursing, University of Ottawa. Ottawa ON.
Davies
Barbara
B
Faculty of Nursing, University of Ottawa. Ottawa ON.
D019317:Evidence-Based Medicine; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D007748:Labor Stage, Second / Q000502:physiology; D008991:Monitoring, Physiologic; D010120:Oxytocics / Q000008:administration & dosage*; D011247:Pregnancy; D013997:Time Factors
D010120:Oxytocics