Comparison of spontaneous pushing and directed pushing during the second stage of labour among Chinese women without epidural analgesia: a protocol of a feasibility study (Preprint)

BACKGROUND Maternal pushing during the second stage of labour could influence labour progress and maternal-neonatal outcomes. Although the image of healthcare providers directing the labouring women to push during the second stage of labour could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effects and outcomes on mother and baby. Meanwhile, a strategy referred to as ‘spontaneous pushing’, which supports women to push by following their bodily urges, has been evaluated in several trials. Notwithstanding the evaluation of spontaneous pushing there is a lack of high-quality evidence to support either of the directed or spontaneous pushing strategies. OBJECTIVE This study aims to test the feasibility of a future randomised controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labour for maternal and neonatal outcomes. METHODS A non-randomised, single group, non-inferiority feasibility study will be conducted in a public hospital in Hebei Province, China. One hundred and five women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing) while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). RESULTS Data collection took place between May and October 2023. A total of 110 women received the intervention of spontaneous pushing. Midwives’ interviews were conducted and will be transcribed for analysis in March, 2024. The data analysis is planned to be completed by May 2024. CONCLUSIONS This feasibility study will provide important information on the conduct of a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomised controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labour and improvement on women’s childbirth experience. CLINICALTRIAL Chinese Clinical Trial Register (ChiCTR2300071178)