Don’t worry about when to start pushing

After carrying a pregnancy for nine months and dealing with associated discomforts such as morning sickness and back pains, most women usually await the due date eagerly.

At the hospital, delivery can take place naturally through vaginal births or surgically via the caesarean section (C-section) operation.

Though both methods are safe, health experts recommend natural births as the better option since surgeries may cause complications such as wound infections. They also lead to longer hospital stays that culminate in high medical bills.

Advantages of natural births include enhanced immunity for the child, early initiation of breastfeeding and faster recovery for the mother.

To ensure that women reap these benefits, doctors encourage natural births.

For a long time, health experts believed that the time women begin to push during labour influences the kind of delivery they will have. But opinions were divided.

Some obstetricians recommend that women should begin pushing as soon the cervix is fully dilated, while others advise waiting until there’s the urge.

For years, doctors have not had conclusive evidence about which approach is better for mothers and their babies.

A new study led by the Washington University School of Medicine in the United States (US) offers a breakthrough.

The research, which involved more than 2,400 first-time pregnant women, shows that the timing of pushing has no effect on whether women deliver vaginally or by C-section.

However, the study findings indicated that women who delayed pushing experienced longer labours and higher risks of severe postpartum (after-birth) bleeding and infections. Their babies also were more likely to develop sepsis — a severe blood infection that can lead to organ damage.

"Obstetricians tend to favour one approach over the other, but no solid evidence has existed to favour either one," said Dr Alison Cahill, the first author of the study and a Washington University associate professor of obstetrics and gynaecology. "We think our findings are likely to change how most obstetric providers manage labour."

The US National Institute of Health funded the new research, which is published in this month’s Journal of the American Medical Association (JAMA).

During the study period, researchers enrolled 2,414 first-time pregnant women at one of six US hospitals that participated in the study between May 2014 and November 2017. The women were at least 37 weeks pregnant with a single pregnancy. They were all given epidural anaesthesia to reduce labour pain.

Once their cervix was fully dilated, at 10 centimetres, hence indicating the beginning of the second stage of labour, the women were randomly assigned to either begin pushing immediately or to delay it for 60 minutes.

According to the results, women in both groups (immediate-pushing and delayed-pushing) had similar chances of giving birth naturally.

However, the immediate group had a shorter average duration of labour — by 32 minutes — compared to the delayed group as well as lower rates of a condition known as chorioamnionitis. This refers to an infection of the placenta and membranes surrounding the foetus or unborn child. However, the immediate group pushed for nine minutes more than the delayed group (83.7 minutes versus 74.5 minutes).

They also had fewer postpartum haemorrhages, compared to the delayed group (2.3 percent versus four percent).

"Pushing during labour is physically demanding and intense. Women look to their obstetric providers for guidance on what's best for them and their babies. Our findings can guide providers to better manage the second stage of labour for optimal health for moms and their babies,” said Dr Cahill.

He stated: “This means avoiding delayed pushing for the sake of increasing the chance of vaginal delivery since it is associated with longer labour time and higher health risks to mothers and babies."