title: Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?
abstract: OBJECTIVE
  To assess, through a literature review, the maternal and neonatal morbidity associated with the type of pushing used during the second stage of labour.
  
  
  METHODS
  We searched the Cochrane Library and the Medline database for randomised controlled trials from 1980 to 2015, using the following keywords: "delivery", "birth", "birthing", "bearing down, coached, uncoached, pushing", "second and stage and labour", "randomised controlled trials" and "meta-analysis".
  
  
  RESULTS
  Seven randomised controlled trials were found. Interventions varied between the studies. In the intervention groups, open-glottis pushing was spontaneous or coached. The groups did not differ for perineal injuries, episiotomies or type of birth. Impact on pelvic floor structure varied between the studies. Only one study found a better 5-minute Apgar score and a better umbilical artery pH in the "open glottis" group.
  
  
  CONCLUSIONS
  The low methodological quality of the studies and the differences between the protocols do not justify a recommendation of a particular pushing technique. Further studies appear necessary to study outcomes with each of these techniques.
authors: Department of obstetrics and gynecology, Clermont-Ferrand university hospital center, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; Clermont université, université d'Auvergne, EA 4681, Perinatalogy, pregnancy, Environment, medical care PRActices and DEvelopment (PEPRADE), 28, place Henri-Dunant, BP 38, 63001 Clermont-Ferrand, France. Electronic address: cbarasinski@chu-clermontferrand.fr.
authors: C
authors: C
authors: Barasinski
authors: Department of obstetrics and gynecology, Clermont-Ferrand university hospital center, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; Clermont université, université d'Auvergne, EA 4681, Perinatalogy, pregnancy, Environment, medical care PRActices and DEvelopment (PEPRADE), 28, place Henri-Dunant, BP 38, 63001 Clermont-Ferrand, France; Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie (AUDIPOG) Sentinel Network, RTH Laennec medical university, 7, rue Guillaume-Paradin, 69372 Lyon cedex 08, France.
authors: D
authors: D
authors: Lemery
authors: Department of obstetrics and gynecology, Clermont-Ferrand university hospital center, site Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; Clermont université, université d'Auvergne, EA 4681, Perinatalogy, pregnancy, Environment, medical care PRActices and DEvelopment (PEPRADE), 28, place Henri-Dunant, BP 38, 63001 Clermont-Ferrand, France; Association des Utilisateurs de Dossiers informatisés en Pédiatrie, Obstétrique et Gynécologie (AUDIPOG) Sentinel Network, RTH Laennec medical university, 7, rue Guillaume-Paradin, 69372 Lyon cedex 08, France.
authors: F
authors: F
authors: Vendittelli
mesh_terms: D001034:Apgar Score; D036861:Delivery, Obstetric / Q000379:methods*; D004841:Episiotomy; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007748:Labor Stage, Second / Q000502:physiology*; D016239:MEDLINE; D036801:Parturition / Q000502:physiology*; D017773:Pelvic Floor; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D014469:Umbilical Arteries
keywords: Coached pushing; Déchirure périnéale; Morbidité néonatale; Neonatal morbidity; Perineal injuries; Poussée dirigée; Pushing techniques; Second stade du travail; Second stage of labour; Type de poussée