title: A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor.
abstract: OBJECTIVE
  To determine which method of pushing-passive descent or early pushing-most benefits women with epidurals during second-stage labor.
  
  
  METHODS
  MEDLINE, CINAHL, and Cochrane Database.
  
  
  METHODS
  Studies limited to randomized controlled trials in English, comparing passive descent to early pushing in women with effective epidural analgesia.
  
  
  METHODS
  A hand search was performed. Data included number of instrument-assisted deliveries (forceps and vacuum); noninstrumental or spontaneous vaginal births, cesarean births, pushing time, episiotomies, lacerations; maternal fatigue; and fetal well-being.
  
  
  RESULTS
  Seven studies were eligible for a sample size of 2,827 women. Pooled data indicate that passive descent increases a woman's chance of having a spontaneous vaginal birth (relative risk: 1.08; 95% confidence interval: 1.01-1.15; p = 0.025), decreases risk of having an instrument-assisted deliveries (relative risk: 0.77; 95% confidence interval: 0.77-0.85; p < or = 0.0001), and decreases pushing time (mean difference: -0.19 hours; 95% confidence interval: -0.27 to -0.12; p < or = 0.0001). No differences were found in rates of cesarean births (relative risk: 0.80; 95% confidence interval: 0.57-1.12; p = 0.19), lacerations (relative risk: 0.88; 95% confidence interval: 0.72-1.07; p = 0.20), or episiotomies (relative risk: 0.97; 95% confidence interval: 0.88-1.06; p = 0.45).
  
  
  CONCLUSIONS
  Significant positive effects were found indicating that passive descent should be used during birth to safely and effectively increase spontaneous vaginal births, decrease instrument-assisted deliveries, and shorten pushing time.
authors.affiliation: Columbia University, New York, NY, USA. rb2449@columbia.edu
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Brancato
authors.forename: Sara
authors.initials: S
authors.lastname: Church
authors.forename: Patricia W
authors.initials: PW
authors.lastname: Stone
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D016001:Confidence Intervals; D036861:Delivery, Obstetric / Q000379:methods* / Q000451:nursing; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second; D009321:Natural Childbirth; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors