Women should push when they feel the urge

Allowing the fetus to passively descend the birth canal (i.e., passive descent) instead of instructing women to push immediately upon full dilation has clear advantages for healthy nulliparous women in the second stage of an uncomplicated labor who are using epidural analgesia. This according to a recent meta-analysis of randomized controlled trials.

The analysis, which includes seven studies involving almost 3,000 women, reveals that passive descent, compared with early pushing, increases a woman's chance of having a spontaneous vaginal birth by about 8% (RR, 1.08; 95% CI, 1.01–1.15; P=.025), decreases the need for an instrument-assisted delivery by almost 25% (RR, 0.77; 95% CI, 0.77-0.85; P≤.0001), and decreases pushing time by a mean difference of –0.19 hours (95% CI, –0.27 to –0.12; P≤.0001).

Researchers found no significant differences in rates of cesarean delivery (RR, 0.80; 95% CI, 0.57–1.12; P=.19), lacerations (RR, 0.88; 95% CI, 0.72–1.07; P=.20), or episiotomies (RR, 0.97; 95% CI, 0.88–1.06; P=.45).