The second stage of labour - the use of interventions and women's experiences

AbstractThe overall aim of this thesis was to explore women´s experiences of the second stage of labour, midwifery practices and the use of interventions.Methods: Study I is a retrospective cohort study where 764 medical records from 2017 were reviewed. Women in Robson group 1 were included. Descriptive and analytic statistics were used to describe the use of oxytocin and to compare mode of birth in Robson group 1. Study II included 21 women with spontaneous vaginal births from 37 gestational weeks who were interviewed about their experiences of the second stage of labour four to ten weeks after birth. Thematic analysis based on descriptive phenomenology was used to analyse data. In study III and IV data from a follow-up questionnaire sent to women one month after birth were used. Inclusion criteria were women opting for their first vaginal birth from 37 gestational weeks with a singleton pregnancy. Study III is a multicentre randomised controlled trial which included 2221 women who were randomised to being assisted by one or by two midwives in the late second stage of labour with the aim of reducing severe perineal trauma. Women’s experiences of the second stage of labour were measured using Likert scales and were analysed according to intention to treat. Study IV is an observational study using data from 2233 women who responded to the follow-up questionnaire sent to women one month after birth. Midwifery practices and interventions used during the second stage were evaluated in relation to informed consent and experiences of the second stage of labour. Analyses were performed with univariate and multivariable logistic regression.Main findings: In study I, oxytocin for labour augmentation was used in 64.1% of the births. Adherence to recommendations and a shorter time treated with oxytocin was associated with a greater likelihood of vaginal birth. In study II women’s experiences of the second stage of labour were described in three themes: “An experience of upheaval”, representing intensity, power and pain. “The importance of trusting relationships” emphasizes the meaning of relationships. “Becoming a mother” describes feelings during the final moments of birth. Study III showed that women’s experiences of the second stage of labour did not differ between women who were randomised to assistance by one or by two midwives in the late second stage of labour. In study IV, provided informed consent to midwifery practices and interventions during the second stage was reported by 17.6% of the women. Informed consent was associated with more positive experiences of the second stage and less discomfort and/or pain from vaginal examinations, episiotomy, perineal massage and catheterization of the bladder. Conclusions: This thesis provides evidence about how the second stage of labour can be experienced by women and how provided informed consent affects women’s experiences during this stage. Being assisted by an additional midwife during the late second stage did not to affect women’s experiences which is of importance as this intervention reduces severe perineal trauma. The findings from this thesis also shed light on a routine use of interventions as well as an overuse of oxytocin for labour augmentation. In conclusion, this thesis contributes to a deeper understanding of how individualized care can be enabled in the significant and transformative life-event of becoming a mother. Key words: Birth experience, interventions, midwifery practices, synthetic oxytocin, the second stage of labou