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.

DESIGN

Randomized clinical trial.

SETTING

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

PATIENTS/PARTICIPANTS: Convenience sample of nulliparous laboring women with epidural anesthesia.

INTERVENTIONS

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

MAIN OUTCOME MEASURES

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.