Can antenatal education influence how women push in labour?
BACKGROUND
Antenatal education on the physiology of second stage of labour and effective pushing has not been studied in the literature. Anecdotal observation seems to indicate that some nulliparous women are (at least initially) unable to push effectively. A large proportion seem to reflexly contract the levator ani muscle when asked to push which may have the effect of slowing the progress of labour.


OBJECTIVE
To test the effectiveness of structured antenatal education for pushing in the second stage of labour versus normal care and its impact on delivery outcome.


METHODS
One hundred nulliparous women between 35 and 37 weeks gestation were randomised.


METHODS
Two 15-min structured education sessions, one week apart, utilising observation of the perineum and a vaginal examination to teach correct technique for relaxing the levator ani muscle and effective pushing.


RESULTS
In both groups, 31 of 50 women (62%) delivered vaginally. Instrumental delivery and caesarean section rates did not differ between the two groups (P = 0.78, relative risk = 1). The mean duration of active second stage for the control group was 53.96 min compared with 57.26 min for the intervention group. This difference of 3.3 min was not statistically significant (P = 0.56). Knowledge of women in the intervention group was increased and the majority of women found the educational sessions helpful.


CONCLUSIONS
Antenatal teaching to ensure effective maternal pushing in labour did not result in altered obstetric outcomes relative to the control group. However, there was a measurable qualitative effect from the intervention in that women clearly felt the education sessions to be helpful.
Phipps
Hala
H
Royal Prince Alfred Hospital, RPA Women and Babies, Camperdown, Sydney, New South Wales, Australia. hala.phipps@email.cs.nsw.gov.au
Charlton
Sarah
S
Dietz
Hans Peter
HP
D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007748:Labor Stage, Second; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010865:Pilot Projects; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care