The article is titled Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: a systemative review and meta-analysis of randomized controlled trials.
This article was a systematic review and meta-analysis of RCTs that included 5,445 women. 2,754 of these women were randomized to the delayed pushing group and 2,691 to the immediate pushing group. These women were evaluated on the effect of delayed versus immediate pushing in the second stage of labor. The primary outcome was the mode of delivery, which included spontaneous vaginal delivery, operative vaginal delivery, and cesarean delivery.
They found that delayed pushing in women with spontaneous or induced labor with an epidural did not affect the mode of delivery. However, it did reduce the time of active pushing at the expense of a longer second stage of labor. This may have resulted in a higher incidence of chorioamnionitis and low umbilical cord pH when compared to immediate pushing once fully dilated to 10 cm.
The clinical bottom line from this study is that delayed pushing cannot be routinely advocated for in the management of the second stage of labor.
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