Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.

Objective: To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue.

Design: Randomized clinical trial.

Setting: Labor and delivery unit of a not-for-profit community hospital.

Patients/participants: Convenience sample of nulliparous laboring women with epidural anesthesia.

Interventions: Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation.

Main Outcome Measures: The length of pushing, total length of the second stage, and maternal fatigue.

Results: A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05).

Conclusions: We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group.