NÄR KROPPEN VILL ELLER NÄR RUMMET KRÄVER? En systematisk integrativ litteraturöversikt om barnmorskors handläggande av utdrivningsskedet med fokus på krysttekniker

Abstract

Title: When the Body Leads or the Room Demands? A Systematic Integrative Literature Review on Midwives’ Management of Pushing Techniques Background: The second stage of labor extends from full cervical dilatation to birth and represents a critical phase of childbirth. A prolonged second stage is associated with increased risks for both the birthing woman and the newborn, while forceful or highly directed management may also have adverse effects. Midwives are responsible for managing this stage to promote a physiological and safe birth while avoiding unnecessary interventions in accordance with evidence-based practice. Different pushing techniques are used in clinical practice, previous research suggests that spontaneous pushing is at least as safe as directed pushing and may be more beneficial for both the birthing woman and the newborn. The theoretical framework Birth Territory is used to contextualize midwives’ management. Aim: The aim was to synthesize existing research on midwives’ management of the second stage of labor, with a focus on pushing techniques. Method: A systematic integrative literature review was conducted. Results: The result includes 17 original studies published between 2005 and 2025. Two main categories were identified. The first category is management styles during the second stage of labor, including spontaneous facilitative, directed approach, and dynamic approach. The second category comprised factors influencing midwives’ choice of pushing technique, such as professional experience and identity, maternal and neonatal circumstances, the influence of epidural analgesia, organizational pressure and environmental pressure. Conclusion: Midwives’ management of the second stage of labor is characterized by dynamic decision-making shaped by professional judgement, the needs of the birthing woman, and organizational conditions. The findings highlight the importance of organizational structures that support professional autonomy and evidence-based practice, as well as the need for further research.