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UBC Theses and Dissertations

Prenatal education : its impact on second stage breathing Selwood, Barbara Lane


An observational study of the impact of prenatal education on the conduct of second stage labour was conducted in the Grace Hospital Low-Risk Labour and Delivery Module. The study participants, 35 prenatal class attenders and 15 non-attenders, were recruited following admission to the hospital during the first stage of labour. Data were collected utilizing three data collection tools: a Childbirth Observation Instrument; a Medical Record Data Form; and, a Postpartum Interview. Findings indicated that the majority of women in the prenatal attender group (74.3%) were English speaking and Caucasian, while the majority of women in the non-attender group (73.3%) were of Asian descent and did not have English as their main language. Fifteen (42.9%) in the prenatal group, and 3 (20%) in the non-attender group received epidural anesthesia during the first stage of labour. Eighteen (51.4%) of the attenders and 4 (26.6%) of the non-attenders required intervention (delivery by forceps or caesarean section); The majority (12 attenders and 2 non-attenders) received epidural anesthesia during the first stage of labour. The majority (62.9% and 66.7%) of attenders and non-attenders used Valsalva pushing throughout the second stage; with 37.1% and 33.3% respectively using spontaneous pushing. Overall 72% of the women were always instructed to use the Valsalva Maneuver and 28% received conflicting guidance (spontaneous and Valsalva), when verbal instructions were given. Two prenatal attenders attributed the breathing techniques used to information received during prenatal classes. Four of the 5 non-attenders who used spontaneous pushing did so because they chose to ignore directions to use Valsalva pushing and used a spontaneous pushing approach. The findings failed to detect a significant difference in the study population due to the limited sample size. The overall second stage duration was 70.4 minutes for attenders and 71.6 minutes for non-attenders. For those women who used spontaneous pushing for the majority of their contractions the second stage was 75.6 minutes and 81.3 minutes respectively; and, 68.3 minutes and 68.0 minutes for those using Valsalva pushing. Apgar scores were the same for both groups —20% scored less than seven and 80% with a score of seven or more at one minute after delivery. Since the study results failed to show that prenatal classes have a significant impact on the conduct of second stage, there is a need for more discussion of the effects of the Valsalva maneuver during prenatal classes and a need for greater emphasis and practice of 'tools' which can be used in coping with second stage contractions.

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