The following is a summary of “Video Instruction for Pushing in the Second Stage: a randomized controlled trial,” published in the JUNE 2023 issue of Obstetrics and Gynecology by Rimsza, et al.
The second stage of labor requires active patient engagement, and previous studies have suggested that coaching can influence its duration. However, no standardized education tool was established, and patients faced barriers to accessing childbirth education before delivery.
For a study, researchers sought to investigate the effect of an intrapartum video-pushing education tool on the duration of the second stage of labor.
A randomized controlled trial was conducted with nulliparous patients with singleton pregnancies of ≥37 weeks of gestation, admitted for induction or spontaneous labor with neuraxial anesthesia. Patients were consented to admission, and the block randomized to one of two arms in a 1:1 ratio. The study arm viewed a 4-minute video before the second stage of labor, providing information on what to anticipate during this stage and pushing techniques. The control arm received the standard of care: bedside coaching at 10 cm dilation from a nurse or physician. The primary outcome was the duration of the second stage of labor. Secondary outcomes included birth satisfaction (using the Modified Mackey Childbirth Satisfaction Rating Scale), mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, and umbilical artery gases. A sample size of 156 patients was needed to detect a 20% decrease in the second stage of labor duration with 80% power, a 2-sided alpha level of 0.05, and 10% loss after randomization. The Lucy Anarcha Betsy Award from the Division of clinical research at Washington University provided funding.
Out of 161 patients, 81 were randomized to the standard of care, and 80 were randomized to intrapartum video education. Among the patients who progressed to the second stage of labor and were included in the intention-to-treat analysis (69 in the video group and 78 in the control group), maternal demographics and labor characteristics were similar between the two groups. The second stage of labor duration was statistically similar between the video arm (61 minutes [interquartile range, 20–140]) and the control arm (49 minutes [interquartile range, 27–131]) (P = 0.77). There was no significant difference in the mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, or umbilical artery gases between the two groups. Although both groups scored similarly on the Modified Mackey Childbirth Satisfaction Rating Scale for overall birth satisfaction, patients in the video group significantly or more favorably rated their “level of comfort during birth” and “attitude of the doctors in birth” (P< 0.05 for both) than patients in the control group.
Intrapartum video education did not lead to a shorter duration of the second stage of labor. However, patients who received video education reported a higher level of comfort and a more favorable perception of their physician, suggesting that video education may be a helpful tool to improve the birth experience.