Video Education for Labor and Delivery

December 8, 2022 updated by: Rebecca Rimsza, Washington University School of Medicine

Impact of a Video Education Tool for the Second Stage of Labor

The second stage of labor or the pushing stage can be challenging and intimidating for patients delivering for the fist time. Among women with neuraxial anesthesia pushing may not be instinctive and therefore various coaching methods are used to maximize maternal expulsive efforts and minimize pushing time. Time intensive strategies including transperineally ultrasound and bio-feedback have been employed to assist with pushing but they are difficult to implement widely. While some women may attend birthing classes or have previously been coached on pushing prior to the onset of labor, many women are unable to access classes prior to labor or do not retain what they learned in a class weeks prior to labor. Previous studies have evaluated the effect of coached pushing on the length of second stage and have indicated that coaching can decrease the second stage up to 13 minutes. In most clinical scenarios, coaching or guidance from the nurse or provider happens once the patient attains complete dilation. There are limitations to this approach as waiting to coach after a potentially long and arduous labor is suboptimal. Therefore, we propose a randomized controlled trial investigating the use of an educational video during the first stage of labor on length of the second stage.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Childbirth education is critical to maternal outcomes. Receiving formal education on the birthing process sets the stage for optimal mother/baby bonding, postpartum mood, and future interactions with healthcare professionals. The American Congress of Obstetrics and Gynecology recommends patients attend birthing classes prior to labor and delivery, however previous studies found that attendance is dropping with only 56% of first-time mothers attending childbirth education classes in 2005 compared to 70% in 2001.

Multiple barriers to accessing prenatal childbirth education have been identified. Traditionally, childbirth education classes are structured as in person lectures with multiple sessions over a period of weeks and are taken prior to the onset of labor. Most childbirth education classes have accompanying costs ranging from $20-$50 for hospital classes and hundreds of dollars for private classes. Significant barriers impact patients ability to attend these classes including difficulty obtaining childcare, financial constraints, getting time off from work, and obtaining transportation. The Coronavirus pandemic has further worsened barriers to accessing childbirth education as most in-person group classes have been cancelled due to lack of funding or need for social distancing.

Most childbirth education focuses on preparation for labor and pain management in the first stage of labor neglecting the second stage. This is the stage of labor that requires the most maternal involvement and effort. Among women with epidural anesthesia pushing may not be instinctive and hence, coaching and preparation are integral to success.

The current standard of care for teaching a patient how to push is nurse-led coaching performed at the bedside immediately before the patient starts pushing. At this point, most patients are tired, anxious, and have not had enough time to process the new knowledge learned about how to push. A long or abnormal second stage is associated with adverse outcomes such as cesarean delivery, infection, and hemorrhage. Nulliparous patients are especially vulnerable to these adverse outcomes in the second stage so long as they do not feel empowered, knowledgeable, or involved in their own birth experiences.

Previous literature shows that coached pushing can decrease second stage duration up to 13 minutes. This is important as a prolonged second stage of labor is associated with maternal and neonatal morbidity including higher rates of cesarean delivery, chorioamnionitis, perineal trauma, NICU admission, neonatal sepsis, and APGAR score < 4 at 5 minutes. In most clinical scenarios, the standard of care is coaching or guidance from the nurse or provider once the patient reaches complete dilation. There are limitations to this approach as waiting to coach after a potentially long and arduous labor course is suboptimal. While physicians and nurses are qualified to coach, they may not be universally available to all patients and the quality of coaching may be impacted by volume and acuity on Labor & Delivery.

In theory, the advent of video-based education can easily be transferred to the hospital to address this issue and allows for education during labor once an epidural is placed, the patient is comfortable, and well before pushing starts. The average duration of labor and delivery in a first-time mother ranges from 14 to 20 hours. This presents an opportune window of time for video-based childbirth education to narrow gaps in childbirth education disparities and increase maternal involvement without the barriers present in the outpatient setting. The efficacy of this novel way of providing childbirth education has not been tested.

To address this quality gap, we propose a randomized trial comparing an intrapartum video education tool to standard provider-based coaching

Study Type

Interventional

Enrollment (Actual)

161

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • Missouri
      • Saint Louis, Missouri, United States, 63108
        • Barnes Jewish Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • Nulliparous women
  • Over 18 year of age
  • Single fetus
  • Term: has completed 36 weeks of pregnancy

Exclusion Criteria:

  • fetal anomalies
  • Prior cesarean delivery
  • contraindication to valsalva
  • blind patients
  • admission in the second stage of labor

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Standard Treatment
Standard bedside coaching by labor and delivery staff
Experimental: Educational Video
Patients will watch the provided coaching video in addition to standard bedside coaching by labor and delivery staff
Other: Childbirth Educational Video
Educational video describing techniques for pushing

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of the Second Stage of Labor
Time Frame: delivery
Time from complete dilation to delivery of the fetus
delivery

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Labor Satisfaction Scores
Time Frame: 1 day ( Assessed via survey prior to discharge from the hospital)
Labor satisfaction as measured by the Mackey Childbirth Satisfaction Rating Scale. Scores are given by patients on a scale from 1-5 with 5 being the highest and 1 being the lowest.
1 day ( Assessed via survey prior to discharge from the hospital)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Washington University School of Medicine

Investigators

  • Principal Investigator: Rebecca R Rimsza, MD, Washington University School of Medicine

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 1, 2021

Primary Completion (Actual)

July 1, 2022

Study Completion (Actual)

August 1, 2022

Study Registration Dates

First Submitted

February 19, 2021

First Submitted That Met QC Criteria

February 22, 2021

First Posted (Actual)

February 23, 2021

Study Record Updates

Last Update Posted (Estimate)

December 12, 2022

Last Update Submitted That Met QC Criteria

December 8, 2022

Last Verified

December 1, 2022

More Information

Terms related to this study

Other Study ID Numbers

  • 202101089

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

No

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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