NEW YORK (Reuters Health) – Allowing a period of rest before pushing is safe and even beneficial for many women and fetuses in the second stage of labor, investigators at Intermountain Health Care in Salt Lake City report in the January issue of Obstetrics and Gynecology.
To settle conflicting reports over whether it is safe to delay pushing once full dilation is achieved, Dr. Susan L. Hansen and colleagues randomized 252 women to active pushing immediately or to a period of rest, allowing passive descent of the fetus. All of the women had epidural anesthesia.
Newborns of women allowed a period of rest had slightly better Apgar scores and umbilical arterial blood pH than controls, although the difference was not statistically significant.
While the second stage of labor was longer in the study group, pushing time was decreased, there were fewer fetal heart rate decelerations and less fatigue among the primiparous women than in controls.
"The beneficial effects of this policy on fatigue, as measured in the early postpartum period in primigravid patients were observed despite the natural euphoria of many such women after having given birth to their first child; thus, the actual beneficial effects may be even greater than we were able to assess," the authors write.
Dr. Hansen and colleagues note that ACOG recommends the second stage of labor not exceed 2 hours in parous women and 3 hours in primigravidas with epidural anesthesia. While a delayed push protocol may prolong the second stage beyond the ACOG guidelines, "in patients too fatigued to push effectively, or those with multiple variable decelerations, a policy of rest and descend appears to be an appropriate option."
Obstet Gynecol 2002;99:29-34.
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