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October 9, 2018

Immediate vs Delayed Pushing During the Second Stage of Labor

Author Affiliations
  • 1Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
JAMA. 2018;320(14):1439-1440. doi:10.1001/jama.2018.12877

Efforts to optimize cesarean delivery rates have prompted research regarding the optimal approach to the management of labor.1,2 The second stage of labor, defined as the interval from complete cervical dilation until delivery of the fetus, is a critical period in labor management. Whether the mother should push immediately or delay pushing for 1 or more hours has been the subject of debate and several observational studies and randomized clinical trials. Although the data may be mixed as a result of efforts to control for mode of delivery and insufficient sample size,3,4 prolonged duration of the second stage of labor is associated with both adverse maternal4 and neonatal outcomes.5 Delayed pushing (also known as laboring down, passive descent, or rest and descend) has not been studied in a high-quality, adequately powered, contemporary randomized clinical trial.6