Pushing/bearing down methods for the second stage of labour

Lemos, Andréa; Amorim, Melânia Maria Ramos; Andrade, Armèle Dornelas de; Souza, Ariani Impieri de; Filho, José Eulálio Cabral; Correia, Juliana Mendes

doi:10.1002/14651858.cd009124.pub3

Cited by 100 publications

(85 citation statements)

References 62 publications

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“…During the second stage of labour, spontaneous versus directed pushing does not result in a clear difference in rates of third or fourth‐degree tears (risk ratio 0.87; 95% CI 0.45–1.66, one study of 320 women) or episiotomy . Similarly, immediate versus delayed pushing in women with an epidural does not result in a clear difference . A review of women’s satisfaction of different pushing techniques using a visual analogue scale found no differences in preference for pushing approaches …”

Section: Resultsmentioning

confidence: 99%

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Wilson

Homer

2020

Aust NZ J Obst Gynaeco

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Background: Third-and fourth-degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third-and fourth-degree tears relative to countries of similar economic development. Aims:We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third-and fourth-degree perineal tears in Australian maternity centres. Materials and Methods:We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Results: Twenty-six systematic reviews were identified. The most common risk factors reported in the literature for third-and fourth-degree tears included primiparity, mother's ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births.Conclusions: Third-and fourth-degree perineal tears are associated with immediate and long-term implications for women and health systems. Evidence-based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do. K E Y W O R D Schild birth, obstetric labour complications, perineal tears, perineum, pregnancy SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article. Table S1. Systematic reviews.

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Section: Resultsmentioning

confidence: 99%

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Wilson

Homer

2020

Aust NZ J Obst Gynaeco

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“…Lemos et al . reported in the Cochrane Database Systematic Review that delayed timing of pushing with epidural analgesia lead to a shortening of the actual time of pushing and an increase of spontaneous vaginal delivery …”

Section: Discussionmentioning

confidence: 99%

Perinatal outcome of vaginal delivery with epidural analgesia initiated at the early or late phase of labor period: A retrospective cohort study in the Japanese population

Shiro

Nakahata

Minami

et al. 2018

J of Obstet and Gynaecol

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“…1 Since there is insufficient evidence to justify routine use of any specific timing of pushing in the second stage, in both centers immediate and delayed pushing approaches were chosen according to women's preference and comfort, and to the preference and experience of the birth attendant. 32 In the 2 participating centers there is no policy to limit the time of second or active second stage of labor and the pushing technique, coached vs spontaneous, is left to the preference of the birth attendant.…”

Section: Methodsmentioning

confidence: 99%

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

Kamel

Montaguti

Nicolaides

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: The Valsalva maneuver is normally accompanied by relaxation of the levator ani muscle, which stretches around the presenting part, but in some women the maneuver is accompanied by levator ani muscle contraction, which is referred to as levator ani muscle coactivation. The effect of such coactivation on labor outcome in women undergoing induction of labor has not been previously assessed. OBJECTIVE: The aim of the study was to assess the effect of levator ani muscle coactivation on labor outcome, in particular on the duration of the second and active second stage of labor, in nulliparous women undergoing induction of labor. STUDY DESIGN: Transperineal ultrasound was used to measure the anteroposterior diameter of the levator hiatus, both at rest and at maximum Valsalva maneuver, in a group of nulliparous women undergoing induction of labor in 2 tertiary-level university hospitals. The correlation between anteroposterior diameter of the levator hiatus values and levator ani muscle coactivation with the mode of delivery and various labor durations was assessed. RESULTS: In total, 138 women were included in the analysis. Larger anteroposterior diameter of the levator hiatus at Valsalva was associated with a shorter second stage (r ¼ e0.230, P ¼ .021) and active second stage (r ¼ e0.338, P ¼ .001) of labor. Women with levator ani muscle coactivation had a significantly longer active second stage duration (60 AE 56 vs 28 AE 16 minutes, P < .001). Cox regression analysis, adjusted for maternal age and epidural analgesia, demonstrated an independent significant correlation between levator ani muscle coactivation and a longer active second stage of labor (hazard ratio, 2.085; 95% confidence interval, 1.158e3.752; P ¼ .014). There was no significant difference between women who underwent operative delivery (n ¼ 46) when compared with the spontaneous vaginal delivery group (n ¼ 92) as regards anteroposterior diameter of the levator hiatus at rest and at Valsalva maneuver, nor in the prevalence of levator ani muscle coactivation (10/46 vs 15/92; P ¼ .49). CONCLUSION: Levator ani coactivation is associated with a longer active second stage of labor.

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Pushing/bearing down methods for the second stage of labour

Abstract: Analysis 1.2. Comparison 1 Analysis 1. Comparison 1: types of pushing: spontaneous pushing versus directed pushing, Outcome 2 Perineal laceration (3rd or 4th degree).

Cited by 100 publications

References 62 publications

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management

Perinatal outcome of vaginal delivery with epidural analgesia initiated at the early or late phase of labor period: A retrospective cohort study in the Japanese population

Contraction of the levator ani muscle during Valsalva maneuver (coactivation) is associated with a longer active second stage of labor in nulliparous women undergoing induction of labor

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