Cochrane – Pushing/bearing down methods for the second stage of labour

I was really interested to read a recent study from Cochrane which discussed (what I thought would be) the best positions for the 2nd stage of labour… All-fours? Standing? Squatting? Crouching-tiger-hidden-dragon?

Well, the paper wasn’t talking about positions for birthing; it was talking about timing of pushing vs. maternal and neonatal outcomes. Oh well, still interesting!

Some terminology

  • Usual practice: women are encouraged to take a deep breath at the beginning of a contraction then hold it and bear down throughout the contraction
  • Spontaneous pushing: women are free to follow their own instincts and generally push three to five times per contraction
  • Epidural anaesthesia: for pain relief, weakens the desire to push
  • Delayed pushing: avoid pushing until there is an irresistible urge to push or when the presenting part of the baby has descended to the perineum (ie. You can see baby’s head at your hoo-haa).

You can read the abstract yourself if you’re interested but in short:

  • With epidural: delayed pushing leads to a shortening of the actual time pushing and increase of spontaneous vaginal delivery at the expense of an overall longer duration of the second stage of labour and double the risk of a low umbilical cord pH (based only on one study)
  • Otherwise there is NO DIFFERENCE between immediate and delayed pushing (eg. C-sections, instrumental deliveries, perineal laceration and episiotomy, neonatal outcomes, effect on maternal pelvic floor)
  • In summary, for the type of pushing, with or without epidural, there is no conclusive evidence to support or refute any specific style or recommendation as part of routine clinical practice.

They conclude that “women should be encouraged to bear down in labour based on their preferences and comfort.”

So you’re telling me that the bottom line of all this data review is for women to labour according to their instincts. Fancy that.

As an aside, they mention “labour” and “comfort” in the same sentence. Can a sentence be an oxymoron?

PS: if you’re not sure what the 1st / 2nd / 3rd stage of labour are, these pretty much sum them up:

1st Stage of Labour

1st Stage of Labour

 

Transition

Transition

 

2nd Stage of Labour

2nd Stage of Labour

 

3rd Stage of Labour

3rd Stage of Labour

 

REFERENCE
Lemos A, Amorim MMR, Dornelas de Andrade A, de Souza AI, Cabral Filho J, Correia JB. Pushing methods for the second stage of labour. Cochrane Database Syst Rev. 2015 Oct 9;10:CD009124.

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