title: Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. The PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group.
abstract: OBJECTIVE
  This study was undertaken to determine whether a policy of delayed pushing for nulliparous women with continuous-infusion epidural analgesia reduces the risk of difficult delivery (cesarean delivery, operative delivery from a midpelvic position, low-pelvic procedures with rotation >45 degrees ).
  
  
  METHODS
  In this multicenter, randomized, controlled trial women in the delayed pushing group (n = 936) were advised to wait > or =2 hours after full dilatation before commencement of pushing. Women in the early pushing group (n = 926) were advised to commence pushing as soon as they had been randomly assigned.
  
  
  RESULTS
  Difficult delivery was reduced with delayed pushing (relative risk, 0.79; 95% confidence interval, 0.66-0.95). The greatest effect was on midpelvic procedures (relative risk, 0.72; 95% confidence interval, 0.55-0.93). Although there was little evidence for an effect on low-pelvic procedures, spontaneous delivery was more frequent among women who practiced delayed pushing (relative risk, 1.09; 95% confidence interval, 1.00-1.18). Abnormal umbilical cord blood pH (<7.15 venous value or <7.10 arterial value) was more frequent in the delayed pushing group (relative risk, 2.45, 95% confidence interval, 1.35-4. 43). However, scores for a summary indicator, the Neonatal Morbidity Index, were similarly distributed in the 2 groups.
  
  
  CONCLUSIONS
  Delayed pushing is an effective strategy to reduce difficult deliveries among nulliparous women.
authors.affiliation: Departments of Obstetrics and Gynecology, Laval University, the Faculty of Nursing, Canada.
authors.forename: W D
authors.initials: WD
authors.lastname: Fraser
authors.forename: S
authors.initials: S
authors.lastname: Marcoux
authors.forename: I
authors.initials: I
authors.lastname: Krauss
authors.forename: J
authors.initials: J
authors.lastname: Douglas
authors.forename: C
authors.initials: C
authors.lastname: Goulet
authors.forename: M
authors.initials: M
authors.lastname: Boulvain
mesh_terms: D015360:Analgesia, Epidural; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007748:Labor Stage, Second; D007744:Obstetric Labor Complications / Q000517:prevention & control; D011247:Pregnancy; D012307:Risk Factors; D013997:Time Factors