October 16, 2018

First-time moms shouldn't wait to push, study says

Daily Briefing

    First-time moms should start pushing during childbirth as soon as they're fully dilated, according to a new study published in JAMA—upending the standard recommendation that women delay pushing for about an hour after dilation.

    Why laboring mothers wait an hour to push

    According to NBC's "Today," many doctors have been instructing laboring mothers who are fully dilated to wait an hour before pushing, based on  a large study, published in the last century, that suggested delaying the push lowered the risk the doctor would need to use forceps or conduct a cesarean section.

    Alison Cahill, an obstetrician at Washington University School of Medicine in St. Louis, who led the latest study, explained, "The thought was perhaps women didn't need to do as much work to push the baby out and that the baby would make progress without those efforts."

    But while forceps were commonly used in deliveries when that study was conducted 20 years ago, Cahill and her colleagues wrote, "[T]hese types of deliveries are obsolete in modern obstetric practice in the United States." And since then, no major study has been conducted to determine the effectiveness of the delayed-push birthing method.

    Study details

    The researchers sought to compare the delayed-push birthing method with an immediate-push method at six U.S. medical centers among more than 2,400 first-time mothers. The study focused on first-time mothers who go into labor at or beyond 37 weeks gestation and received pain medication for labor and delivery.

    The researchers randomly assigned the women to one of two groups: One group was told to start pushing as soon as they reached complete cervical dilation, while the other was told to wait an hour after dilation to begin pushing.

    The rate of C-sections did not vary between the two groups, according to the study. However, the researchers did observe some benefits to the immediate-push method. They found 4% of the women who waited to push had excessive bleeding after delivery, compared with 2.3% of the women who pushed immediately. Similarly, 9.1% of the women who waited to push ended up with bacterial infections, compared with 6.7% of the women who pushed right away.

    They also found the second stage of labor was about 30 minutes faster for women who pushed immediately than for those who waited to push. According to Cahill, "that shorter second stage of labor is healthier for both moms and babies."

    Discussion

    Cahill said this new study "suggest[s] that women becoming moms for the first time should begin pushing right away when they become completely dilated, for the best outcome for themselves and for their babies."

    Menachem Miodovnik, from the National Institute of Child Health and Human Development, which helped pay for the study, said, "The findings provide strong evidence that for the vast majority of first-time mothers receiving epidural anesthesia, delaying pushing offers no benefit over immediate pushing at the second stage of labor."

    Christopher Zahn, VP of practice activities at the American College of Obstetricians and Gynecologists, said the study was "very well done" and showed there are no significant health benefits to delaying pushing, but rather potential for adverse events. He added that the ACOG plans to update its practice guidelines based on these findings (Neighmond, "Shots," NPR, 10/9; Fox, "Today," NBC,10/9).

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