In childbirth, when to begin pushing during labor does not affect C-section rates

image credit: verywellfamily.com

More than 3 million women in the United States give birth each year. But obstetricians have differing opinions about when women should begin pushing during labor and whether the timing of pushing increases the likelihood of a cesarean section, which carries a higher risk of complications compared with a vaginal delivery.

Many obstetricians recommend that a woman begin pushing as soon the cervix is fully dilated, while others advise waiting until she feels the urge to push. Until now, doctors have not had conclusive evidence about which approach is better for mothers and their babies.

Now, a multicenter study led by Washington University School of Medicine in St. Louis and involving 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, women who delayed pushing experienced longer labors and higher risks of severe postpartum bleeding and infections. Their babies also were more likely to develop sepsis -- a serious complication related to infection.

Is Fever During Labor a Risk to Mother?

via whattoexpect.com

"Intrapartum fever -- fever that occurs during labor -- occurs in approximately 1-2% of deliveries and is often associated with maternal and neonatal complications. But the precise reasons for the fever and its different outcomes are unclear.

A new Tel Aviv University study finds a link between the duration of intrapartum fever and maternal complications; and, when intrauterine infection is a trigger for the fever, a link between the fever and subsequent neonatal complications.

The study was led by Dr. Liran Hiersch, of TAU's Sackler School of Medicine and Tel Aviv Medical Center, together with Dr. Eran Ashwal, also of Sackler and Tel Aviv Medical Center. It was published recently in the Journal of Maternal-Fetal and Neonatal Medicine.
 

A new link between fever and infection

"We set out to explore which specific maternal and neonatal complications are associated with intrapartum fever. More specifically, we were interested to learn if the presence of abnormal bacterial cultures affected the duration of the fever. This would indicate that the fever is probably due to intrauterine infection, affecting the risk of complications in the mother," Dr. Hiersch says.

The research is a retrospective study of 309 women admitted for vaginal delivery at full term to Rabin Medical Center in Israel. The perinatal outcomes of the deliveries complicated by intrapartum fever (body temperature equal to or greater than 100.4°F/38.0°C) were compared to those of 618 women who delivered without intrapartum fever..."

Learn more:

https://www.sciencedaily.com/releases/2017/09/170928113016.htm

 

Allowing women to extend labor reduces rate of cesarean delivery

via healthline.com

"When women in labor are given more time to deliver their baby than current guidelines recommend, their incidence of cesarean delivery drops by 55 percent, say researchers at Thomas Jefferson University.

Their study, in the March issue of the American Journal of Obstetrics and Gynecology, is the first to formally test what happens when women in the second stage of labor (fully dilated) are given four hours, instead of three, if they did have an epidural.

Not only was the incidence of cesarean delivery reduced by more than 50 percent, there were no associated negative health consequences to the mother or child, says the study's lead author, Alexis C. Gimovsky, M.D., a Maternal Fetal Medicine Fellow at The Sidney Kimmel Medical College of Thomas Jefferson University.

The findings suggest that the two-hour rule, which dates back to the 1800s, needs to updated, she says. "This was a small study, so a formal change in guidelines should be based on a larger sample of women. But this study shows what we have observed in practice—there is benefit to allowing women to labor longer..."

Read more here:

http://medicalxpress.com/news/2016-03-women-labor-cesarean-delivery.html