By implementing this evidence midwives may enable women during the second stage of labour to optimise physiological processes to give birth. The empirical findings were synthesised into four main themes namely: birthing positions, non-pharmacological pain relief, pushing techniques and optimising perineal outcomes the results were outlined and discussed. The remainder of the included studies were primarily intervention studies, highlighting aspects of midwifery practice during the second stage of labour. Two studies surveyed midwives regarding their practice and one study utilising focus groups explored how midwives facilitate women’s birthing positions, while another focus group study explored expert midwives’ views of their practice of preserving an intact perineum during physiological birth. 17 studies focusing on midwives’ practices during physiological second stage of labour were included. Articles were then assessed for quality by two independent researchers and data extracted. Bibliographic databases searched included: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Maternity and Infant Care Database and The Cochrane Library, resulting in 6,382 references to be screened after duplicates were removed. A systematic literature search was performed to September 2019 in collaboration with a medical information specialist. We conducted a systematic review of the literature to retrieve evidence that supports high quality intrapartum care during the second stage of labour. A midwife’s practice can be influenced by education and cultural practices but ultimately it should be informed by up-to-date scientific evidence. All rights reserved.Both nationally and internationally, midwives’ practices during the second stage of labour vary. The information gathered by clinical examination and ultrasound should be integrated into clinical decision making.Ĭardinal movements fetal attitude fetal descent fetal position mechanics of labor ultrasound.Ĭopyright © 2021 The Authors. Ultrasound offers a historically unique opportunity for noninvasive, dynamic studies of the mechanics of labor. We would argue that descent is the main purpose of the uterine powers and cardinal movements, a description of the rotational movements the fetal head and shoulders must perform to obtain descent. German and older English literature lists only 4 rotational movements as the cardinal movements and excludes engagement, descent, and expulsion. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. The fetus negotiates the birth canal and rotational movements are necessary for descent. Electronic address: mechanics of labor describe the forces required for fetal descent, and the movements that the fetus must perform to overcome the resistance met by the maternal bony pelvis and soft tissue. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (Drs Kahrs and Eggebø) Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (Drs Kahrs and Eggebø) Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway (Dr Eggebø).
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