title: The Ottawa Hospital's Clinical Practice Guideline for the Second Stage of Labour.
abstract: 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.
authors.affiliation: Perinatal Partnership Program of Eastern and Southeastern Ontario, Ottawa ON.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Sprague
authors.affiliation: Department of Obstetrics and Gynecology and the Maternal/Newborn Program, The Ottawa Hospital, Ottawa ON.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Oppenheimer
authors.affiliation: Department of Obstetrics and Gynecology and the Maternal/Newborn Program, The Ottawa Hospital, Ottawa ON.
authors.forename: Linda
authors.initials: L
authors.lastname: McCabe
authors.affiliation: Department of Obstetrics and Gynecology and the Maternal/Newborn Program, The Ottawa Hospital, Ottawa ON.
authors.forename: Janet
authors.initials: J
authors.lastname: Brownlee
authors.affiliation: Faculty of Nursing, University of Ottawa. Ottawa ON.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.affiliation: Faculty of Nursing, University of Ottawa. Ottawa ON.
authors.forename: Barbara
authors.initials: B
authors.lastname: Davies
mesh_terms: 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
chemical_list: D010120:Oxytocics