Midwives’ experiences of managing the premature

Abstract

The aim of this study was to explore midwives’ experiences of managing the premature urge to push during the first stage of labour. The study’s objectives were to explore midwives’ views of, and approaches to Early Pushing Urge (EPU), as well as to explore how midwives help women cope with the early urge to push. To fulfil the study’s aim and objectives, a qualitative approach was adopted and face-to-face, semi-structured interviews were conducted with a purposive sample of six midwives. A response rate of 100% was achieved. The interviews were audio-recorded and transcribed verbatim. Data was analysed using thematic analysis, as described by Braun and Clarke (2006). The findings of this study indicated that midwives vary in their views about the nature of EPU. While some midwives view EPU as a physiological part of labour, others argue that it could be a sign of complications. Midwives discussed various factors perceived as influencing the onset of EPU, primarily citing fetal malpositions and malpresenatations. The effects of EPU on the labour process were also discussed with midwives mainly perceiving EPU to have a negative effect on labour. Midwives’ approach to EPU varied, with some advising the stop-pushing technique and others suggesting that women should follow their bodily instincts. Preferred management techniques were influenced by the stage of cervical dilatation and maternal parity. Midwives’ views of, and approach to, EPU had often evolved over the course of their career, becoming more physiological over time. Both non-pharmacological and pharmacological methods were used by midwives to help women cope with EPU, with midwifery presence and support being considered particularly important. Overall results suggested a lack of clarity regarding the nature of EPU and the optimal way to manage it. On the basis of the results a number of recommendations for practice, education and further research are suggested, such as the need for large-scale quantitative research to identify the true nature of EPU allowing for development of tailored management techniques.