Nulliparous women's lived experiences of the prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology.

INTRODUCTION: Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage. OBJECTIVE: To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women. METHODS: A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. RESULTS: The analysis resulted in four themes: "An unknown phase" that entailed remaining in a phase that the women lacked an awareness of. "Trust and mistrust in the body's ability" represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme "Loss of control" included experiences of frustration, fatigue, and having to deny bodily instincts. "Support through presence and involvement" signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence. CONCLUSIONS: The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

Mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour: A retrospective cohort study of nulliparous women.

OBJECTIVE: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women. METHODS AND FINDINGS: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120-239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience. CONCLUSIONS: Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Prolonged passive second stage of labor in nulliparous women-Prevalence and risk factors: A historical cohort study.

INTRODUCTION: This study examined the prevalence of and risk factors for a prolonged passive second stage of labor in nulliparous women. MATERIAL AND METHODS: This was a historical cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. Duration of the passive second stage was measured as time from retracted cervix to start of pushing. Prolonged passive second stage was defined as ≥2 h. Prevalence was calculated and associations between prolonged passive second stage and maternal, obstetric and neonatal characteristics and potential risk factors were assessed using logistic regression models. RESULTS: The prevalence of prolonged passive second stage was 37.6%. Factors associated with an increased risk of prolonged passive second stage were epidural analgesia (adjusted odds ratio [aOR] 3.93; 95% confidence interval [CI] 2.90-5.34), malpresentation (aOR 2.26; 95% CI 1.27-4.05), maternal age ≥ 30 years (aOR 2.00; 95% CI 1.50-2.65) and birthweight ≥ 4 kg (aOR 1.50; 95% CI 1.05-2.15). Maternal body mass index ≥30 (aOR 0.52; 95% CI 0.34-0.79) and noncohabiting (aOR 0.51; 95% CI 0.30-0.89) reduced the odds of prolonged passive second stage. CONCLUSIONS: A prolonged passive second stage of labor in nulliparous women is common (n = 425 [38%]). We found epidural analgesia, malpresentation, maternal age ≥ 30 years and birthweight ≥4 kg to be major risk factors associated with an increased risk of a prolonged passive second stage. Birth outcomes for prolonged passive second stage need to be investigated to strengthen evidence for the management of the second stage of labor.

Using the Internet as a source of information during pregnancy - A descriptive cross-sectional study in Sweden.

OBJECTIVE: The Internet plays a major role for pregnant women in seeking knowledge and for getting in touch with like-minded women. The information is available at all hours and can be accessed anywhere. The information provides the women with a sense of control and confidence but the large amount of information available can also be overwhelming. The aim of this study was to identify how women use the Internet as a source of information during their pregnancy and how it affects them. DESIGN AND SETTING: A descriptive cross-sectional study was conducted.Data were collected through a questionnaire at antenatal clinics in the southern Sweden. The data were analyzed descriptively PARTICIPANTS: A total of 193 Swedish women, pregnant at least 34 weeks, participated in the study. The response rate was 94%. FINDINGS: Almost all (95%) of the women in the study used the Internet as a source of information. The main reason was to find information and read about people in the same situation. Reading pregnancy-related information on the Internet was seen as positive. However, a majority of the woman experienced feelings of worry due to something they read online. These feelings were most commonly coped with by talking to a partner, relatives, and friends or by asking the midwife at their next appointment. Eleven per cent of the women contacted the general healthcare services because of their feelings of worry. CONCLUSION: Almost all women in this study searched the Internet to find pregnancy-related information, despite being satisfied with the information they received from the ANC. Using the Internet was seen as complementary to the information from professionals. It also caused feelings of worry, which could lead to the woman contacting healthcare services for support. ANC could help to reduce these feelings for some women by informing about the advantages and disadvantages with online information and recommending suitable web pages.