Women In Labor Shouldn’t Wait To Push, According To A New Study
Giving birth for the first time is pretty nerve-wracking, which is one of the many reasons why we rely on our doctors and their extensive knowledge. It turns out, though, that one popular perspective on first-time deliveries may not be as helpful as previously thought: a new study has found that women in labor shouldn't wait to push once they are fully dilated, even though many obstetricians actually recommend the practice.
The belief, according to NPR, was that waiting up to about an hour after reaching full dilation could result in an easier, less complicated delivery for first-time moms. To test that theory, the research team, led by OB Dr. Alison G. Cahill of Washington University in St. Louis, studied the births of 2,414 women who'd delivered at one of six preselected medical centers in the United States. All of the women were admitted when they were at least 37 weeks gestation, either because they were already in labor or because they were set to be induced, and all of them received an epidural. In order to see whether waiting was actually helpful, half of the women were instructed to start pushing as soon as they became fully dilated, while the other half were instructed to wait for one hour before beginning to push.
The outcome? It turns out that women in both groups had a similar chance in delivering vaginally — about 86 percent. That means that delaying pushing didn't actually reduce the likelihood of first-time mothers requiring C-sections, though it does seem that delaying pushing can be more dangerous. For one, immediate pushing led to a decreased risk of chorioamnionitis, a bacterial infection causing inflammation of the fetal membranes and can cause prolonged labor. The women who pushed right away also had a lower risk for postpartum hemorrhages — 2.3 percent of women who pushed immediately had excessive bleeding, compared to 4 percent of women who waited.
Those findings are perhaps the most important discovery from the study, since they can actually be life-threatening. But even without serious complications, there doesn't actually appear to be any benefit to delaying pushing. For one, women who pushed immediately had a shorter second stage of labor on average — they delivered about half an hour sooner than those in the delayed group, even though they spent about nine more minutes actively pushing.
Given that delaying pushing doesn't actually seem to decrease the likelihood of a C-section, the study suggests there really isn't any value in instructing women to wait. Add in the fact that there could actually be a higher risk for complications, as well as a longer delivery, and the benefits of immediate pushing seem to win out. And while a 30-minute difference in the length of second-stage labor may not have a huge effect on outcomes, it does still matter: according to the American College of Obstetricians and Gynecologists, a prolonged second stage of labor (longer than about three hours for first-time moms) can increase the need for a C-section — major abdominal surgery that carries greater risk than vaginal deliveries.
In other words, the study's findings suggest that if you're a first-time mom in labor, it's probably best to start pushing as soon as you reach 10 centimeters. As nice as it would be to think waiting a bit longer could make for an easier, smoother delivery, the research suggests most moms likely won't benefit. And given that there also appears to be higher risks for some potentially-very-serious complications, it definitely seems wise to talk to your OB ahead of time about pushing as soon as possible.