Pushing/bearing down methods for the second stage of labour

Area of Science:

• Obstetrics and Gynecology
• Perinatal Care
• Evidence-Based Medicine

Background:

• Maternal pushing is crucial for spontaneous expulsive force during labor's second stage.
• Optimal strategies for facilitating maternal pushing remain debated, with conflicting evidence on maternal and fetal impacts.

Purpose of the Study:

• To evaluate the benefits and disadvantages of different maternal pushing/breathing techniques during labor's expulsive stage.
• To assess the impact of these techniques on maternal and fetal outcomes.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched Cochrane Pregnancy and Childbirth's Trials Register and reference lists.
• Included 21 studies comparing spontaneous vs. directed pushing (with/without epidural) and delayed vs. immediate pushing (with epidural).

Main Results:

• No clear differences in maternal or neonatal outcomes between spontaneous and directed pushing.
• Delayed pushing (with epidural) increased the second stage of labor duration but decreased pushing time and increased spontaneous vaginal delivery rates.
• Delayed pushing was associated with a higher incidence of low umbilical cord pH and increased healthcare costs, with no clear differences in severe perineal lacerations or episiotomies.

Conclusions:

• Insufficient evidence to recommend specific maternal pushing styles or timing.
• Decisions on pushing techniques should consider maternal preference, comfort, and clinical context.
• Further high-quality RCTs are needed to inform clinical practice regarding maternal pushing strategies.