Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial.

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.