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首页> 外文期刊>The Journal of perinatal & neonatal nursing >Labor down or bear down: A strategy to translate second-stage labor evidence to perinatal practice
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Labor down or bear down: A strategy to translate second-stage labor evidence to perinatal practice

机译：降低劳动强度或降低劳动强度：将第二阶段劳动证据转化为围产期实践的策略

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摘要

Scientific evidence supports spontaneous physiologic approaches to second-stage labor care; however, most women in US hospitals continue to receive direction from nurses and birth attendants to use prolonged Valsalva bearing-down efforts as soon as the cervix is completely dilated. Delaying maternal bearing-down efforts during second-stage labor until a woman feels an urge to push (laboring down) results in optimal use of maternal energy, has no detrimental maternal effects, and results in improved fetal oxygenation. Although most commonly used with women who are undergoing epidural anesthesia, laboring down is just one component of physiologic second-stage labor care that can be used to achieve optimal maternal and neonatal outcomes for women with or without an epidural. Prior efforts to translate evidence regarding second-stage labor care to practice have not been successful. In this article, the scientific evidence for second-stage labor care and previous efforts at clinical translation are reviewed. The Ottawa Hospital Second Stage Protocol is presented as a model with potential to allow translation of evidence to practice. Recommendations to enhance widespread adoption of evidence-based practice are provided, including improved collaboration between nurses and birth attendants.
机译：科学证据支持第二阶段劳动保健的自发生理方法;但是，在美国医院中，大多数妇女在子宫颈完全扩张后仍继续接受护士和接生员的指导，以长期使用Valsalva向下压的方法。延迟产妇在第二阶段分娩时的努力，直到妇女感到有催促（分娩）的冲动时，才能最佳地利用产妇的能量，没有有害的产妇影响，并改善胎儿的氧合作用。尽管分娩时最常使用硬膜外麻醉的妇女，但分娩只是生理性第二阶段分娩护理的一个组成部分，可用于为有或没有硬膜外分娩的妇女实现最佳的母体和新生儿结局。先前将有关第二阶段劳动保健的证据转化为实践的努力并未成功。在本文中，将对第二阶段劳动保健的科学证据以及先前在临床翻译方面的努力进行综述。 《渥太华医院第二阶段议定书》是作为一种模型提出的，具有使证据转化为实践的潜力。提供了一些建议，以促进广泛采用循证实践，包括改善护士与接生员之间的合作。

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