Does Postponing Pushing Prolong Parturition?

Summary and Comment |
November 30, 2016

Does Postponing Pushing Prolong Parturition?

  1. Allison Bryant, MD, MPH

Delayed pushing in the second stage of labor lengthened this stage and raised risk for cesarean delivery.

  1. Allison Bryant, MD, MPH

The practice of “laboring down” (allowing passive fetal descent prior to active pushing in the second stage), touted to increase the likelihood of vaginal delivery, has become increasingly popular. Still, the efficacy of this strategy has not been demonstrated. To determine the association between delayed pushing and perinatal outcomes, investigators conducted a secondary analysis of a multicenter, observational cohort study of >23,000 nulliparous women with singleton, vertex, nonanomalous fetuses.

Delayed pushing was more common among white, older, privately insured women who had augmented or induced labors and epidural anesthesia. The procedure was more common during daytime hours than at night. After adjustment, delayed pushing was associated with greater likelihood of cesarean delivery (adjusted odds ratio, 1.86), operative vaginal delivery (aOR, 1.26), and blood transfusion (aOR, 1.51). On average, the second stage lasted 117 minutes longer among women who delayed pushing.

Comment

Few would challenge the view that the cesarean delivery rate in the U.S. is too high. Interventions to decrease the likelihood of operative delivery are welcome, but they must be informed by evidence. This well-conducted study — despite the limitations common to observational studies — clearly demonstrates that encouraging women to rest at the start of labor's second stage is not likely to be a winning strategy when it comes to mode of delivery.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Nothing to disclose

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