Second Stage of Labor Risk and Management

Course overview

The second stage of labor creates a physiologic challenge to both mother and fetus. Oxygen delivery is reduced while oxygen consumption increases during this phase of labor. Certain interventions may help or hinder oxygenation. Using closed-glottis (Valsalva) pushing is now considered acceptable along with open-glottis pushing. However, the practice of prolonged, coached pushing is discouraged due to the impact to PO2 and perineal tissue damage. Current recommendations are to encourage the patient to push as is most comfortable and effective for them. This course identifies factors that increase risk exposure and barriers that may make malpractice allegations more likely. Analysis of a case study shows how mismanagement of the second stage can lead to serious reportable events that place the providers, hospital, and health system at risk for malpractice claims.