{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T01:48:45Z","timestamp":1789177725982,"version":"build-2803163510"},"reference-count":44,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2010,12,24]],"date-time":"2010-12-24T00:00:00Z","timestamp":1293148800000},"content-version":"vor","delay-in-days":1391,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Midwife Womens Health"],"published-print":{"date-parts":[[2007,3,4]]},"abstract":"<jats:p>A supportive approach to care for women during the second stage of labor that primarily relies on the laboring woman's involuntary expulsive urges has been advocated. We aimed to learn about the clinical circumstances surrounding the caregiver shift from being primarily supportive to directing women regarding their bearing\u2010down efforts. This research analyzed the communications of 10 birth attendants and women during the expulsive phase of labor using videotapes recorded from two studies carried out between 1986 and the present. The occasions when a birth attendant shifted verbalizations were identified, and categories of the rationales that may have influenced the modification in caregiver behavior were developed. Birth attendants most frequently provided directions to help the woman push effectively, that is, to focus the woman's bearing\u2010down efforts during maternal distress, fatigue, fear, and pain to expedite the labor process (38% of the occasions of caregiver change in verbalizations). The next most frequent clinical situations when caregivers offered directions about \u201cpushing\u201d were diminished urge to bear\u2010down with epidural analgesia (10%), routine arbitrary practices (9% caregiver and 6% by supportive companion), and fetal distress (&lt; 1%). A category of \u201csupportive direction\u201d (20%) was identified. This care strategy has not been previously reported. It combined direction with support in a way that was supportive rather than overriding the woman's involuntary efforts.<\/jats:p>","DOI":"10.1016\/j.jmwh.2006.11.005","type":"journal-article","created":{"date-parts":[[2007,3,2]],"date-time":"2007-03-02T17:47:01Z","timestamp":1172857621000},"page":"134-141","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Why Do Supportive Birth Attendants Become Directive of Maternal Bearing\u2010Down Efforts in Second\u2010Stage Labor?"],"prefix":"10.1111","volume":"52","author":[{"given":"Joyce M.","family":"Roberts","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celina B. 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