The use of epidural anesthesia for pain control in labor and delivery is widely accepted throughout the U.S. with prevalence rates reported for many hospitals as high as 98 percent. However, a paucity of research has been reported on how standards for second stage labor care that are based on the common management guidelines used for non-anesthetized women, should be adapted in relation to interventions such as assistance with bearing-down or pushing efforts, positioning, and resting time intervals for women receiving epidural anesthesia. Since the trend toward use of epidural anesthesia during the intrapartum is predicted to continue, interdisciplinary nursing and medical research is necessary to provide data to use in developing care guidelines for the second stage of labor that: 1) define acceptable parameters for length and progress; 2) reduce the risk for adverse fetal/neonatal outcomes; 3) minimize maternal fatigue and perineal trauma; 4) reduce the incidence of failure to progress , maternal fatigue/exhaustion and fetal distress as indications for instrumental/assisted or cesarean deliveries; and 5) promote maternal satisfaction with the childbirth experience. The study aims are to determine if there is a difference in maternal, fetal and neonatal outcomes based on the use of a rest and descend nursing care protocol for second stage labor versus a """"""""standard"""""""" nursing care protocol. In addition, data on the relationship of anesthesia outset and duration, maternal positions, and pushing/rest patterns to the designated maternal and fetal/neonatal outcomes will be obtained. A randomized, controlled experimental design will be used to study the research aims in two labor and delivery units. Based on power analysis calculations, a total sample of 630 nulliparous women will be recruited and randomized into either the control group (n=315) or experimental group (n=315). Analysis procedures for testing statistically significant group differences will include a combination of Frequentist/Bayesian, Chi-square, multiple regression, logistic regression and loglinear analysis procedures.
