Date of Award

Spring 2010

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Hansen, Lisa C.

Second Advisor

VandeVusse, Leona

Third Advisor

Harrod, Kate


A growing body of evidence suggests that spontaneous pushing during the second stage of labor results in better outcomes than directed pushing, which usually involves repeated use of the Valsalva maneuver. However, birth attendants in the United States (U.S.) continue to use directive methods when caring for women in the second stage of labor. This study used quantitative methods with the Theory of Diffusion of Innovations as a framework to identify and describe the practices used by certified nurse-midwives and certified midwives, practicing in the U.S., when caring for women in second stage labor. Data were gathered using a questionnaire mailed through the U.S. Postal Service. Implications for nursing practice, nursing education and nursing research are identified. The literature regarding what is known about pushing methods used during second stage labor is reviewed, as well as the philosophical underpinnings and theoretical framework of the present study. Findings revealed that midwives provide care during second stage labor that is primarily supportive of women's physiologic urge to bear down. When midwives use directive methods, they do so as an intervention to prevent potential problems. Further, midwives offer "supportive direction" in response to cues they receive from women in labor.

Included in

Nursing Commons