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Labor Down or Bear Down: A Strategy to Translate Second-Stage Labor Evidence to Perinatal Practice

Osborne, Kathryn PhD, CNM, FACNM; Hanson, Lisa PhD, CNM, FACNM

Journal of Perinatal & Neonatal Nursing:
doi: 10.1097/JPN.0000000000000023
Feature Articles

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.

Author Information

Department of Midwifery and Women's Health, Frontier Nursing University, Hyden, Kentucky (Dr Osborne); and Marquette University, College of Nursing, Milwaukee, Wisconsin (Dr Hanson).

Corresponding Authors: Kathryn Osborne, PhD, CNM, FACNM, Department of Midwifery and Women's Health, Frontier Nursing University, 195 School St, Hyden, KY 41749 (

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Submitted for publication: October 19, 2013; accepted for publication: February 17, 2014.

© 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins.