Video Education for Labor and Delivery

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

Sponsors

Lead Sponsor: Washington University School of Medicine

Source Washington University School of Medicine
Brief Summary

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.

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

Overall Status Not yet recruiting
Start Date April 1, 2021
Completion Date November 1, 2022
Primary Completion Date July 1, 2022
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Length of the Second Stage of Labor delivery
Secondary Outcome
Measure Time Frame
Labor Satisfaction Scores 1 day ( Assessed via survey prior to discharge from the hospital)
Enrollment 152
Condition
Intervention

Intervention Type: Other

Intervention Name: Childbirth Educational Video

Description: Educational video describing techniques for pushing

Arm Group Label: Educational Video

Eligibility

Criteria:

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

Gender: Female

Gender Based: Yes

Minimum Age: 18 Years

Maximum Age: N/A

Healthy Volunteers: No

Overall Contact

Last Name: Rebecca R Rimsza, MD

Phone: 314-747-2362

Email: [email protected]

Verification Date

February 2021

Responsible Party

Type: Principal Investigator

Investigator Affiliation: Washington University School of Medicine

Investigator Full Name: Rebecca Rimsza

Investigator Title: Clinical Fellow

Has Expanded Access No
Number Of Arms 2
Arm Group

Label: Standard Treatment

Type: No Intervention

Description: Standard bedside coaching by labor and delivery staff

Label: Educational Video

Type: Experimental

Description: Patients will watch the provided coaching video in addition to standard bedside coaching by labor and delivery staff

Patient Data No
Study Design Info

Allocation: Randomized

Intervention Model: Parallel Assignment

Primary Purpose: Health Services Research

Masking: None (Open Label)

Source: ClinicalTrials.gov