When Should a Woman Start Pushing During Labor?

Women who delay pushing down during labor do not have increased cesarean rates, but have a higher risk of bleeding and infection following delivery as well as an increased risk of infection in their babies.

Highlights:

Obstetricians are currently not clear, if delaying pushing down by a woman in labor can increase risk of cesarean section
Delay in pushing does not increase cesarean rates, but can affect the overall health of both mother and the baby

Delayed pushing by a woman during childbirth does not increase cesarean risk, according to a recent multicenter study led by Washington University School of Medicine in St. Louis. The study, backed by the National Institutes of Health (NIH), appears in the Journal of the American Medical Association.

Labor-Introduction
Childbirth is one of the most marvelous and memorable segment in a woman's life that calls for celebration. Knowledge about labor and delivery can ease unnecessary fear, ensuring a unique experience.

‘Delaying pushing during childbirth associated with increased health risks to both mother and the baby. Therefore, obstetricians should favor immediate pushing by women during childbirth to shorten duration of second stage as well as lower associated health risks to the woman and her baby following delivery.’
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Are Cesarean Section Rates Increased by Delaying Pushing Down During Labor?

Nearly 3 million deliver in the US annually and attending doctors have differing opinions on when a woman in labor should start pushing to increase the chances of a normal vaginal delivery. Some obstetricians feel that a woman should start pushing once the cervix is fully dilated while others say that a woman should begin to push only when she feels the urge to do so.

The current multicenter study hoped to address this question and find out if the timing of pushing could influence cesarean section rates.

Timing of Pushing and Cesarean Section Rates

The current study included 2,414 first time pregnant women attending one of six centers between May 2014 and November 2017
All women were at least 37 weeks pregnant with a singleton pregnancy, and all of them had been given epidural anesthesia for pain control
When the cervix was fully dilated at 10 centimeters (beginning of the second stage of labor), the women were randomly assigned to either start pushing immediately or to delay pushing for another 60 minutes
In the immediate-pushing group, 1,031 (85.9 percent) women had a normal vaginal delivery compared with 1,041 (86.5 percent) in the delayed-pushing group, a difference not considered statistically significant

"The findings provide strong evidence that for first-time pregnant women receiving epidurals, immediate versus delayed pushing during the second stage of labor (period between full cervical dilation and delivery of the baby) did not affect vaginal delivery rates," said Menachem Miodovnik, MD, a medical officer at the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development.

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Timing of Pushing and Overall Health Risk for Mother and Baby

Although cesarean risk was not increased by delay in pushing, other interesting findings were noted in the study.

Women in the immediate-pushing group had significantly lesser rates of infections and fewer occurrences of heavy bleeding after delivery.
Only 80 (6.7 percent) women who began pushing immediately developed an infection compared with 110 women (9.1 percent) who delayed pushing
In addition, only 27 (2.3 percent) women assigned to push immediately suffered severe postpartum bleeding, compared with 48 (4 percent) women who delayed pushing
Women who pushed early had a shorter second stage of labor (102.4 minutes) by an average of at least 30 minutes, compared with women in the delayed pushing group (134.2 minutes)
Babies born to mothers in the immediate-pushing group had significantly lower rates of neonatal infections (38 or 3.2 percent) compared with those in the delayed-pushing group (53 or 4.4 percent), respectively

Alison G. Cahill, MD, the study's first author, a Washington University associate professor of obstetrics and gynecology and director of the Division of Maternal-Fetal Medicine, "Obstetricians tend to favor one approach over the other, but no solid evidence has existed to favor either one. We think our findings are likely to change how many obstetric providers manage labor. Previous studies comparing the immediate versus pushing approaches involved small numbers of patients, and results were often contradictory and inconclusive."

Cesarean Deliver and Other Complications can be Averted by Inducing Labor at 39 Weeks
Cesarean delivery can be prevented if labor is induced in healthy pregnant women at 39 weeks, says study.

Conclusion

Women trust their obstetricians and look up to them for guidance, and to make decisions that would impact their health as well as their baby’s health. The findings of the study could guide doctors attending deliveries to manage the second stage of labor better in order to ensure the best possible outcome for both the mother and her baby. In other words, obstetricians should favor immediate pushing by women during childbirth to shorten duration of second stage as well as lower associated health risks to the woman and her baby following delivery.

References:

In childbirth, when to begin pushing does not affect C-section rates - (https://medicine.wustl.edu/news/in-childbirth-when-to-begin-pushing-does-not-affect-c-section-rates/)

Source-Medindia