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Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural
Erica Gillesby1, Suzan Burns, Amy Dempsey
1Labor & Delivery, Exempla Lutheran Medical Center, Wheat Ridge, CO 80033, USA. gillesbye@exempla.org
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.
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