Pushing techniques in the second stage of labour

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Labor and Delivery

Background:

• Directed pushing, involving breath-holding and forceful expulsion, is a common practice during the second stage of labor.
• Current clinical guidelines lack robust scientific evidence to support the routine use of directed pushing techniques.

Purpose of the Study:

• To compare the safety and feto-maternal outcomes of spontaneous versus directed pushing during the second stage of labor.
• To investigate the association between the duration of the second stage of labor and fetal well-being under different pushing strategies.

Main Methods:

• A randomized controlled trial was conducted comparing spontaneous pushing with directed pushing in women during labor.
• Outcomes assessed included feto-maternal adverse effects and venous cord blood pH as an indicator of fetal status.

Main Results:

• No adverse effects were observed in either mothers or neonates in the spontaneous pushing group.
• A significant negative correlation was found between the length of the second stage and cord blood pH in the directed pushing group, indicating potential fetal disadvantage.
• This association was not present in the spontaneous pushing group, even with a longer mean second stage duration.

Conclusions:

• Spontaneous pushing during the second stage of labor is a safe alternative to directed pushing.
• Directed pushing may be associated with adverse fetal outcomes, particularly when the second stage of labor is prolonged.
• Clinical practices regarding pushing techniques in labor should be re-evaluated based on available scientific evidence.