Nigel Lee1, Yu Gao2, Lauren Lotz3, Sue Kildea2. 1. Midwifery Research Unit, Level 2 Aubigny Place, Mater Research, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia. Electronic address: nigel.lee@uq.edu.au. 2. Midwifery Research Unit, Level 2 Aubigny Place, Mater Research, South Brisbane, Queensland 4101, Australia; School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia. 3. School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, University of Queensland, St Lucia, Queensland 4072, Australia.
Abstract
AIM: To compare the effect of directed or spontaneous maternal pushing effort on duration of second stage labour, perineal injury and neonatal condition at birth. METHODS: A retrospective cross-sectional design provided data for term women with singleton, cephalic presentation experiencing a non-operative vaginal birth without regional analgesia from January 2011 to December 2017 (n=69,066) Participants matching the inclusion criteria (n=19,212) were grouped based upon spontaneous or directed pushing. Propensity score matching was used to select equally sized cohorts of similar characteristics (n=10,000). The associations with outcomes of interest were estimated using odds ratios obtained by multivariate analysis. FINDINGS: Directed pushing was associated with a longer duration of second stage labour for nulliparous (mean 14.4min [12.0-16.8]) and multiparous (mean 8.0min [6.8-9.2]) women, and an increased risk of prolonged 2nd stage of labour in multiparous women. The use of episiotomy in the directed pushing group was significantly higher both prior to and following PS matching and adjustment. Directed pushing was also associated with an significantly increased risk of neonatal resuscitation and nursery admission. There was no difference in rates of Apgar <7 recorded at 5min of age. CONCLUSION: Directed pushing is associated with an increased duration of second stage labour and risk of adverse neonatal outcomes. Our study suggests that in the absence of regional analgesia women should be supported to follow their own expulsive urges.
AIM: To compare the effect of directed or spontaneous maternal pushing effort on duration of second stage labour, perineal injury and neonatal condition at birth. METHODS: A retrospective cross-sectional design provided data for term women with singleton, cephalic presentation experiencing a non-operative vaginal birth without regional analgesia from January 2011 to December 2017 (n=69,066) Participants matching the inclusion criteria (n=19,212) were grouped based upon spontaneous or directed pushing. Propensity score matching was used to select equally sized cohorts of similar characteristics (n=10,000). The associations with outcomes of interest were estimated using odds ratios obtained by multivariate analysis. FINDINGS: Directed pushing was associated with a longer duration of second stage labour for nulliparous (mean 14.4min [12.0-16.8]) and multiparous (mean 8.0min [6.8-9.2]) women, and an increased risk of prolonged 2nd stage of labour in multiparous women. The use of episiotomy in the directed pushing group was significantly higher both prior to and following PS matching and adjustment. Directed pushing was also associated with an significantly increased risk of neonatal resuscitation and nursery admission. There was no difference in rates of Apgar <7 recorded at 5min of age. CONCLUSION: Directed pushing is associated with an increased duration of second stage labour and risk of adverse neonatal outcomes. Our study suggests that in the absence of regional analgesiawomen should be supported to follow their own expulsive urges.
Authors: Maria C P Vila Pouca; Marco P L Parente; Renato M Natal Jorge; John O L DeLancey; James A Ashton-Miller Journal: Int Urogynecol J Date: 2021-11-16 Impact factor: 2.894
Authors: Maria C P Vila Pouca; João P S Ferreira; Marco P L Parente; Renato M Natal Jorge; James A Ashton-Miller Journal: Am J Obstet Gynecol Date: 2022-01-31 Impact factor: 10.693