Simpson, K. R., & James, D. C. (2005).Nursing Research, 54, 149-157.

This is an important study for nurses who work with laboring patients to read, because it deals with the effects of two different methods of nursing care on fetal oxygen saturation during the second stage of labor. Forty-five healthy, nulliparous women were studied and randomized into two groups (immediate or delayed pushing). Fetal oxygen saturation was continuously monitored. The study also evaluated other determinants of fetal well-being, including FHR patterns, Apgar scores, umbilical cord blood gases, length of labor, method of birth, and perineal status. The researchers found that fetal oxygen desaturation over the course of second-stage of labor (from 10 cm dilation to immediately before birth) was significantly greater in the immediate pushing group compared to the delayed pushing group. There were significant differences between groups in the number of variable FHR decelerations and the number of prolonged FHR decelerations. There were no significant differences for other types of FHR patterns, umbilical cord gases, or Apgar scores. The average length of active pushing for the immediate pushing group was significantly longer as compared to the delayed pushing group, but there was no difference in the total length of labor between the groups. No differences were found in terms of maternal birth outcome. No differences were found for cesarean births, operative vaginal births, or episiotomies between groups. More women in the immediate pushing group had perineal lacerations, however. Labor and delivery nurses can use this study to support nursing care that allows the fetus to passively descend until the woman feels the urge to push and avoid coaching women to bear down with prolonged periods of coached closed glottis pushing. This study should be shared with L&D nurses for discussion.

Maaly Kamal Gumei