Active second-stage duration under 15 minutes in spontaneous vaginal deliveries with delayed pushing

To describe the duration of active pushing in spontaneous vaginal deliveries managed with a delayed pushing policy of up to 3 hours after full cervical dilation.

A retrospective single-center cohort study was conducted from March 2018 to June 2024 at Besançon University Hospital, France. We included 10,565 term singleton pregnancies with cephalic presentation resulting in spontaneous vaginal delivery regardless of parity, epidural use, or labor induction status. The duration of pushing was analyzed by passive second-stage length, parity, fetal position and station, use of epidural analgesia, and labor induction.

Mean pushing duration was 8.8±7.9 minutes (median, 6; range, 0-64). Duration increased with longer passive second stages: 7.5 minutes after ≤1 hour, 10.9 minutes after 2 hours, and 14.2 minutes after 3 hours of full dilatation (P<.01). Multiparas pushed significantly less than nulliparas (5.9 vs 14 minutes, P<.01). Shorter durations were also associated with anterior fetal position (9 vs 10.5 minutes in posterior/transverse fetal position, P<.01), lower fetal station at onset (6 minutes at outlet vs 8.7-9.8 minutes in higher stations, P<.01), absence of epidural (6.6 vs 9.3 minutes, P<.01), and spontaneous labor (8.7 vs 9.6 minutes in induced labor, P<.01). Maternal and neonatal outcomes were overall reassuring, with a low rate of immediate postpartum hemorrhage (5.1%) and very low incidence of severe perineal trauma (0.5%). Neonatal status at birth was also favorable: 99.2% of newborns had an Apgar score >7 at 5 minutes and 73.4% had an arterial cord pH ≥7.2.

Under a delayed pushing policy of up to 3 hours, active pushing remained less than 15 minutes, supporting high rates of spontaneous vaginal birth and potentially reducing the need for instrumental delivery.