第二产程晚用力产妇自主用力原则.docVIP

The Second Stage of Labour. Are we pushing too hard? /webfiles/Literature%20review/Second%20stage%20paper.doc#_Does_length_of_time affect fetal we (assessed 1o-4-2009) Good practice guidelines: Care within the second stage should be non-prescriptive, thereby facilitating spontaneous, instinctive maternal behaviour.不要指导，提倡母亲自发的，自主的行为（用力方式） There should be no arbitrary time limit for the second stage of labour in the presence of maternal and fetal well-being.不应当强行（机械的，武断）的限制产程的时间而不考虑母亲和胎儿的情况 Routine Valsalva or breath-holding style pushing can have harmful effects on the mother and fetus.常规的屏气用长力的用力方式母亲和胎儿是有害的 Women should be supported and encouraged to push spontaneously, which will often include vocalisation.鼓励产妇自发的用力 Midwives should adopt a flexible approach to the early pushing urge depending on the extent of dilation of the cervix and other signs of maternal well-being. 助产士应该根据宫口开大情况和母亲的情况来判断是否让产妇用力 During the initial latent phase of second stage there may be no urge to push. This is normal and women should not be directed to push during this phase.在第二产程的早期（LATENT潜伏期，第二产程的被动期）产妇可能不想用力，这是正常的，不应当在这个时期指导产妇用力 Delayed pushing until there is an urge to push should be used for women who have had epidural anaesthesia.延迟用力的时间，直到产妇自已想用力。这也适用于应用麻醉镇痛的妇女 Women should be encouraged to adopt upright positions during the second stage to encourage fetal descent and avoid instrumental delivery.鼓励产妇第二产程采用直立体位（包括直立，行走，坐，蹲，跪，手膝支持的俯卧（ ON HANDS AND KNEES）。这有利于胎儿下降，减少阴道助产。 Key Messages: When the second stage of labour is progressing, and the condition of both mother and fetus is satisfactory, there is no evidence to support the arbitrary imposition of time limits on its duration (Enkin et al., 2000). Adverse outcomes attributed to prolonged second stage are consequent on underlying causative factors and not on the absolute duration of second stage (Sleep, 1990). There is evidence to support delayed pushing during second stage labour to allow passive fetal descent, until the woman