Practices during the active second stage of labor: A survey of French midwives

Objective: the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase).

Design: this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013.

Setting: this open survey was posted on a website from June 15 through December 1, 2014.

Participants: 1496 midwives from 377 maternity units participated in the study.

Measurements and findings: the midwives most often reported suggesting horizontal positions during the active second stage (supine with footholds, lithotomy, lithotomy with knees turned in, or lateral positions). Non-horizontal positions were more often proposed by midwives in level I units (p<0.0001). Almost half the midwives responding (46.4%), especially those working in level III units (51.1%, p = 0.006), advised Valsalva pushing. The mean maximum pushing time was 35.3 minutes±12.8 minutes. Nearly all the midwives favored the 'hands on' technique at childbirth (91.4%), and 24% reported using warm compresses on the perineum at childbirth.

Key conclusion: most midwives advised horizontal positions for childbirth. The practices of French midwives differed as a function of where they worked. The midwives, especially those in level III facilities, reported that they cannot always ensure 'physiological childbirth'.

Implications for practice: the practices of French midwives must become more evidence-based. The development of professional guidelines for midwives in France appears essential. This study also helps to prioritise national training for midwives.