Original Research: Obstetrics|Articles in Press

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

Published:March 18, 2023DOI:
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      AJOG at a Glance

      • 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.
      • 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.
      • 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.



      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


      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


      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.


      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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