Pushing/bearing down methods for the second stage of labour

Area of Science:

• Obstetrics
• Maternal-Fetal Medicine
• Evidence-Based Practice

Background:

• Maternal pushing is crucial for labor progression.
• Optimal pushing strategies lack consensus, with conflicting evidence on maternal and fetal effects.

Purpose of the Study:

• To evaluate maternal and fetal outcomes of different pushing/breathing techniques during labor's expulsive stage.

Main Methods:

• Systematic review of randomized and quasi-randomized trials.
• Searched Cochrane Pregnancy and Childbirth Group's Trials Register.
• Included studies comparing timing (immediate vs. delayed) and type (Valsalva vs. other) of pushing.

Main Results:

• Delayed pushing with epidural prolonged labor but increased spontaneous vaginal delivery; no difference in perineal trauma or neonatal outcomes, but higher risk of low umbilical cord pH.
• No significant differences in maternal or neonatal outcomes between spontaneous and directed pushing types.
• Studies had high or unclear risk of bias.

Conclusions:

• Insufficient evidence to routinely recommend specific pushing timing or type.
• Patient preference and clinical context should guide decisions.
• Further high-quality trials are needed to clarify benefits and risks.