Delayed pushing with lumbar epidural analgesia in labour.

Seventy-six primigravidae with epidural analgesia were randomly assigned to one of two groups for management in the second stage. In one group the women delayed pushing and in the other they were managed conventionally. The two groups were well matched for maternal and infant characteristics, including position and level of the presenting part at full dilatation and fetal scalp blood pH. The mean waiting time in the second stage before pushing was increased from 27 min in the conventional group to 123 min in the delayed group. This delay was not associated with an increase in abnormal fetal heart rate abnormalities or any decrease in umbilical cord pH or Apgar scores. In contrast, the delay was associated with an increase in spontaneous deliveries and a decrease in forceps deliveries (P = 0.06). These findings suggest a need for redefining the management of the second stage of labour with epidural analgesia.