Passive descent in the second stage: evaluation of variation in practice patterns ^*

Objective: To compare the length of the second stage in nulliparous women with respect to a range of factors related to staffing and outcomes at a community hospital. Methods: This was a retrospective cohort study of nulliparous women presenting for delivery over a 2-year period. The primary outcomes were the presence of passive descent and length of the second stage. Secondary outcomes were mode of delivery, chorioamnionitis, and postpartum hemorrhage. Results: Passive descent was observed in 198 women in the second stage. When passive descent occurred, the differences in the median length of the second stage in relation to the nursing shift increments were statistically significant, with the longest times corresponding to the middle 4 h of the nursing shifts (p =.046). Physician patients were more likely than midwife patients to undergo passive descent on weekdays (36% vs. 26%, p =.034) but not on weekends (32% for both). Though the likelihood of a vaginal delivery remained high up to 6 h into the second stage, the rate of hemorrhage and chorioamnionitis increased significantly. Conclusions: When passive descent occurred, second stage length varied depending on the time of day. These findings suggest provider behaviors impact the length of the second stage.