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Original Research: Obstetrics|Articles in Press

Video Instruction for Pushing in the Second Stage (VIPss): A randomized controlled trial

Published:March 18, 2023DOI:https://doi.org/10.1016/j.ajog.2023.03.024
Video Instruction for Pushing in the Second Stage (VIPss): A randomized controlled trial
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      AJOG at a Glance

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        Why was this study conducted? The second stage of labor requires maternal involvement and participation but most patients do not prepare for this during pregnancy. Given the many barriers to receiving childbirth education, there is a need for innovative labor education modalities. We investigated the effect of intrapartum pushing education on second stage duration.
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        What are the key findings? Intrapartum video education was not associated with a shorter second stage but was associated with improved maternal comfort during delivery.
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        What does this study add to what is already known? Intrapartum video education was identified as an underutilized time to deploy educational material and has the potential to improve patient satisfaction.

      Abstract

      Background

      The second stage of labor requires active patient engagement. Prior studies suggest that coaching can influence second stage duration. However, a standardized education tool has not been established and patients face many barriers to accessing childbirth education before delivery

      Objective

      We investigated the effect of an intrapartum video pushing education tool on second stage duration.

      Study Design

      This was a randomized controlled trial of nulliparous patients with singleton pregnancies ≥37 weeks admitted for induction or spontaneous labor with neuraxial anesthesia. Patients were consented on admission and block randomized in active labor to one of two arms in a 1:1 ratio. The study arm viewed a 4-minute video prior to the second stage on what to anticipate in second stage and pushing techniques. The control arm received the standard of care: bedside coaching at 10cm dilation from a nurse or physician. The primary outcome was second stage duration. Secondary outcomes were birth satisfaction (using Modified Mackey Childbirth Satisfaction Rating Scale), mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, and umbilical artery gases. 156 patients were needed to detect a 20% decrease in second stage duration with 80% power, 2-sided alpha 0.05, and 10% loss after randomization

      Results

      Of 161 patients, 81 were randomized to standard of care and 80 to intrapartum video education. Among these, 149 progressed to the second stage and were included in the intention-to-treat analysis: 69 video and 78 control. Maternal demographics and labor characteristics were similar between groups. Second stage duration was statistically similar between the video arm (61min [IQR 20-140]) and the control arm (49min [IQR 27-131]), P=0.77. There were no differences in mode of delivery, postpartum hemorrhage, clinical chorioamnionitis, neonatal intensive care unit admission, or umbilical artery gases between groups. Although the overall birth satisfaction score on the Modified Mackey Childbirth Satisfaction Rating Scale was similar between groups, patients in the video group rated their “level of comfort during birth” and “attitude of the doctors in birth” significantly higher/more positively than control patients.

      Conclusion

      Intrapartum video education was not associated with a shorter second stage. However, patients who received video education reported higher level of comfort and a more favorable perception of their physician, suggesting that video education may be a helpful tool to improve the birth experience.

      Key Words

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      Article info

      Publication history

      Accepted: March 12, 2023
      Received in revised form: February 16, 2023
      Received: December 9, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      https://drive.google.com/file/d/1Tr146MJWikk1pNEX6B3qXAlVLwk1bz3F/view?usp=sharing

      Study was conducted in Saint Louis, Missouri. USA.

      Disclosures: The authors report no financial conflict of interest.

      Funding: The study was funded by the L.A.B Award from the Washington University, Department of Obstetrics and Gynecology, Division of Clinical Research.

      Dr. Raghuraman is supported by Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number K23HD098315 and the Doris Duke Foundation.

      Clinical Trials Registration

      Date of Registration: January 23rd, 2021

      Date the first patient was enrolled: March 5th, 2021

      Clinical trial identification number: NCT04766099

      URL of registration site: https://clinicaltrials.gov/ct2/show/NCT04766099

      Data sharing: Individual participant data is stored in a REDCap database and is available for sharing for all parties interested in conducting secondary analyses. All de-identified patient data and outcomes will be shared. In addition, the study protocol and data dictionary will also be shared. Data will be available upon final publication.

      The data included will be presented as an Oral Presentation as Abstract #36 the 43rd Annual Pregnancy Meeting, Society for Maternal Fetal Medicine, February 10th, 2023.

      Tweetable statement: Video instruction for pushing in the second stage was not associated with a shorter second stage but was associated with improved maternal comfort.

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2023.03.024

      Copyright

      © 2023 Elsevier Inc. All rights reserved.

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