Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.
OBJECTIVE
To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue.


METHODS
Randomized clinical trial.


METHODS
Labor and delivery unit of a not-for-profit community hospital.


METHODS
Convenience sample of nulliparous laboring women with epidural anesthesia.


METHODS
Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation.


METHODS
The length of pushing, total length of the second stage, and maternal fatigue.


RESULTS
A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05).


CONCLUSIONS
We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group.
Labor & Delivery, Exempla Lutheran Medical Center, Wheat Ridge, CO 80033, USA. gillesbye@exempla.org
Erica
E
Gillesby
Suzan
S
Burns
Amy
A
Dempsey
Shirley
S
Kirby
Kami
K
Mogensen
Kelly
K
Naylor
Joann
J
Petrella
Rebecca
R
Vanicelli
Breon
B
Whelan
D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods* / Q000451:nursing; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007748:Labor Stage, Second / Q000502:physiology*; D010298:Parity; D017060:Patient Satisfaction; D005082:Physical Exertion; D011247:Pregnancy; D011256:Pregnancy Outcome; D013997:Time Factors; D014590:Uterine Contraction / Q000502:physiology; D055815:Young Adult