BACKGROUND:
Although guidelines are set by WHO for childbirth pushing techniques during the second stage of labor, different methods are often used in practice.

OBJECTIVES:
This study aimed to understand the actual verbal encouragement and cues provided by midwives for pushing to primiparas undergoing epidural childbirth and identify associated challenges of these pushing techniques during the second stage of labor.

METHODS:
Semi-structured interviews were conducted. The participants were midwives who had experience providing epidural childbirth. The data were analyzed using qualitative inductive methods from five perspectives: (1) timing of pushing; (2) Instructions to women on how to push effectively; (3) actual maternal position and conditions; (4) how midwives learn pushing techniques; and (5) challenges of childbirth pushing.

RESULTS:
Five midwives determined the timing to initiate childbirth pushing based on factors such as the condition of the fetus and the state of the birth canal. Explanation about pushing to these women giving birth was sometimes provided earlier than the timing recommended by the WHO guidelines. Regarding the maternal position during childbirth pushing, midwives considered factors such as the fetal condition, the progress of labor, maternal fatigue, and the potential impact on postpartum recovery. Instructions about childbirth pushing were provided step-by-step, with support aimed at enabling the mother to feel a sense of participation. Regarding the acquisition of effective childbirth pushing techniques by midwives, it was noted that there are no formal educational programs specifically focused on pushing during an epidural childbirth, and that there are limited learning resources available for midwives.

CONCLUSIONS:
To enable effective childbirth pushing during an epidural childbirth, it is essential for midwives reflect on their own practice and enhance education opportunities for midwives.

KEY MESSAGE:
Midwives are often not formally trained in managing the second stage of labor for women undergoing epidural childbirth and typically acquire these skills through on-the-job experience. Poster session 2 (Group A)