title: Medical and nonmedical factors influencing utilization of delayed pushing in the second stage.
abstract: OBJECTIVE
  To evaluate factors impacting selection to delayed pushing in the second stage of labor.
  
  
  METHODS
  This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modeling was used to identify factors independently associated with delayed pushing.
  
  
  RESULTS
  We identified 471 women who delayed pushing and 4819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second-stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing.
  
  
  CONCLUSIONS
  We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second-stage labor management.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri 63110, USA. FreyH@wudosis.wustl.edu
authors.forename: Heather A
authors.initials: HA
authors.lastname: Frey
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.forename: Sarah
authors.initials: S
authors.lastname: Cortez
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Shanks
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000765:Anesthesia, Conduction; D015992:Body Mass Index; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007748:Labor Stage, Second / Q000208:ethnology; D016015:Logistic Models; D015999:Multivariate Analysis; D010298:Parity; D062209:Patient Handoff; D010561:Personnel Staffing and Scheduling; D011247:Pregnancy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D055815:Young Adult