Related Experiment Video
Updated: Sep 24, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 28, 2010
Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a
S Vause1, H M Congdon, J G Thornton
1Department of Obstetrics and Gynaecology, North Manchester General Hospital, UK.
Objective:
To test the hypothesis that a policy of delaying active pushing in nulliparous women with epidural analgesia in labour reduces operative vaginal deliveries.
Design:
A randomised controlled trial.
Setting:
The delivery suite at Leeds General Infirmary.
Sample:
One hundred and thirty-five nulliparous women with an effective epidural in labour.
Methods:
The women were randomised to early pushing (commencement of pushing within one hour of the diagnosis of full dilatation) or delayed pushing (delaying pushing for a maximum of three hours from the time of diagnosis of full dilatation, unless the vertex was visible at the introitus sooner.
Main Outcome Measure:
Rate of instrumental vaginal delivery.
Results:
There was a nonsignificantly increased rate of instrumental vaginal delivery with early pushing (odds ratio 1.31, 95% CI 0.62-2.78). No adverse effects were noted.
Conclusion:
Although delayed pushing was associated with fewer instrumental vaginal deliveries, the size of the effect may have occurred by chance and the evidence does not, at present, justify a general recommendation towards either early or delayed pushing.
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