Design: This pilot study utilized a comprehensive literature review and an anonymous cross-sectional survey design. Surveys were mailed to 500 maternity care agencies in the United States, Canada, and Mexico with a return rate of 17.8% (n=89). Each participating agency was asked to submit five patient cases to be included in the analysis.

Sample and Setting: The sample of patient cases (n=419) was drawn from randomly selected maternity care agencies throughout North America representing all sizes of agencies and geographic locations. The cases submitted for analysis represented women 14 to 44 years of age with varying ethnicities who received no regional anesthesia or oxytocin augmentation or induction.

Results: The average length of the second stage of labor for women today is similar to the length described by Friedman in 1954. However, a wider range of “normal” was found in the current study. A review of literature suggests non-directive pushing and a greater variety of birthing positions improves second stage labor outcomes. 87.6% of nurse managers believed that the Friedman’s Labor Curve should be revised to meet the needs of current patient populations, technological advances, and nursing responsibilities.

Conclusions: The parameters, assessments, and interventions currently employed during the second stage of labor need to be re-evaluated to incorporate the most recent evidence to support best practices.

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Sigma Theta Tau International
July 21, 2004