NWH: Improving Nurse Management of the Second Stage of Labor

Improving Nurse Management of the Second Stage of Labor



To develop, implement, and evaluate an educational program to improve nurses’ management of the second stage of labor.


Evidence-based practice project guided by the Iowa Model–Revised.


Acute care teaching hospital in central California averaging 2,100 births/year with 12 labor, delivery, and recovery rooms and a Level III nursery.


Eighteen registered nurses participated in the educational intervention.


An instructional course addressed contemporary labor management guidelines and delayed and open/closed glottis pushing. Assessment/documentation of maternal–fetal status, progress/fetal descent, and nurse/provider communication were discussed. Participants engaged in an interactive experience regarding maternal positions.


Data collected from the electronic health record included the number of position changes, nurse/provider communication interactions, and minutes from 10 cm to birth and minutes in delayed pushing.


Second-stage labor outcomes for nulliparous patients at term with a singleton in vertex presentation improved with more position changes and percentage of spontaneous vaginal births. Patients of nurses who participated in the educational intervention (n = 18) had a vaginal birth rate of 87.5% and a surgical birth rate of 6.2%. Patients of nurses who did not participate in the educational intervention (n = 31) had a vaginal birth rate of 81.8% and a surgical birth rate of 9.1%.


Based on the positive response to the intervention and improved clinical outcomes, regularly scheduled interactive nursing education focused on strategies to improve the second stage of labor may be beneficial.