The power of silence: maternal and neonatal outcomes from a comparison of spontaneous and directed pushing in second stage labour

Abstract

Background: Directed pushing is commonly used to reduce the duration of the second stage of labour; however the research is inconclusive regarding maternal and fetal benefits or harm associated with directed pushing. Limitations identified in previous studies relate largely to small sample sizes that were inadequate to measure association with uncommon but potentially serious outcomes. Purpose: The objective of the study was to compare the effect of directed or spontaneous maternal pushing effort on duration of second stage labour, perineal injury and neonatal condition at birth. Methods: Using a retrospective cross-sectional design, data for term women with singleton, cephalic presentation experiencing a non-operative vaginal birth without regional analgesia from January 2011 to December 2017 (n = 69,066) were extracted from the perinatal database of a metropolitan tertiary hospital in Brisbane. The directed and spontaneous pushing groups were based upon the midwives reporting of the approach used and recorded in the perinatal database. Propensity score matching was used to select equally sized cohorts of similar characteristics (n = 10,000). The associations with outcomes of interest were estimated using odds ratios obtained by multivariate analysis.