Pushing in the second stage of labour: Part 1

Abstract

The second stage of labour has traditionally been managed by the midwife, directing women how and when to push. This usually involves women being instructed to use the Valsalva manoeuvre within prescribed time limits in supine or lithotomy positions. The rationale is that the duration of second stage of labour is reduced and therefore the risks of adverse effects to mother and fetus minimised. However, there is accumulating evidence that directed pushing within arbitrary time limits in supine positions is disadvantageous to the woman and fetus and is actually unjustified. Spontaneous pushing, which allows the woman to follow her own instincts and push in the second stage of labour, does not put the women or the fetus at risk of adverse effects. On the contrary, it offers clear benefits to both. Furthermore, the woman should be allowed to adopt positions that are most comfortable for her, yet encourage fetal rotation and descent through the maternal pelvis. The positions adopted can be variable, as long as labour is progressing, although upright positions are advocated during the second stage of labour compared to supine positions, which are not recommended.