HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hansen, S. L. Articles by Foster, J. C. Search for Related Content PubMed PubMed Citation Articles by Hansen, S. L. Articles by Foster, J. C.

Active Pushing Versus Passive Fetal Descent in the Second Stage of Labor: A Randomized Controlled Trial

From Intermountain Health Care, Salt Lake City, Utah.

Address reprint requests to: Steven L. Clark, MD, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143.

OBJECTIVE: To compare perinatal outcomes among women with epidural anesthesia who were encouraged to push at complete dilatation with those who had a period of rest before pushing began.

METHODS: After a power analysis to determine appropriate sample size (based upon an error rate of .05% and 80% power), a prospective randomized trial of 252 women with epidural anesthesia was conducted. Patients were randomized to a rest period or immediate pushing at complete dilatation. Variables measured included rate of fetal descent, length of time of pushing, the number and type of fetal heart rate decelerations, Apgar scores, arterial cord pH values, perineal injuries, type of delivery, length of second stage, maternal fatigue, and endometritis.

RESULTS: When a period of rest was used before pushing, we found a longer second stage, decreased pushing time, fewer decelerations, and, in primiparous women, less fatigue compared with control patients. Apgar scores, arterial cord pH values, rates of perineal injury, instrument delivery, and endometritis were similar in both groups.

CONCLUSION: Delayed pushing was not associated with demonstrable adverse outcome, despite second-stage length of up to 4.9 hours. In select patients, such delay may be of benefit.

This article has been cited by other articles:

				B. A. Plunkett, A. Lin, C. A. Wong, W. A. Grobman, and A. M. Peaceman Management of the Second Stage of Labor in Nulliparas With Continuous Epidural Analgesia Obstet. Gynecol., July 1, 2003; 102(1): 109 - 114. [Abstract] [Full Text] [PDF]

				C. A. Wong, B. M. Scavone, S. Dugan, J. C. Smith, H. Prather, J. N. Ganchiff, and R. J. McCarthy Incidence of Postpartum Lumbosacral Spine and Lower Extremity Nerve Injuries Obstet. Gynecol., February 1, 2003; 101(2): 279 - 288. [Abstract] [Full Text] [PDF]

				Resting During the Second Stage of Labor Is Safe Journal Watch Women's Health, February 19, 2002; 2002(219): 5 - 5. [Full Text]