2023-05-11 08:00:27
In France, more than 700,000 deliveries take place each year. A major event in the life of the parents, as in that of the unborn child. Recommendations define the conduct to be followed by the obstetrical teams in the course of childbirth. A recent French study looked at the effect of a push delayed by a few hours on the course of childbirth. Results.
Childbirth: should the mother push as soon as the cervix is completely dilated?
It is customary to say that every childbirth is different, an adage approved by many women who have experienced several deliveries. But from the point of view of the obstetrical teams, the course of thechildbirth is the subject of recommendations on the interventions to be carried out according to the parameters observed by the midwives. From one country to another, the recommendations and practice obstetrical teams vary.
In the practices of obstetrical teams, one point in particular is subject to variations in the recommendations: the delay before the pushing effort. The pushing effort begins once the dilation of the cervix is complete and it is necessary to obtain the exit of the fetus and therefore its birth. Depending on the practice, the delay between complete dilation and the pushing effort is more or less long. In a recent study, researchers evaluated the interest of extending this time by a few hours.
Delaying pushing for up to 3 hours before delivery reduces the risk of medical or surgical intervention
This retrospective observational study was conducted in 2016 on 614 nulliparous women (giving birth to their first child), with no particular obstetrical risk, and pregnant with a single child (with a pregnancy carried to term). These women gave birth in two different maternities:
- In maternity A (305 women), the women, after full cervical dilationunder epidural analgesia, benefited from a delay of 3 hours after complete dilation to begin the pushing effort;
- In maternity B (304 women), women only had 2 hours to start pushing effort.
The data collected showed that women who gave birth in maternity A had a significantly lower risk of giving birth by caesarean section than women who gave birth in maternity B (18.4% versus 26.9%). This reduction in the risk of medical intervention during childbirth was confirmed after adjusting for data on maternal age, women’s Body Mass Index (BMI) or gestational age at childbirth (number of weeks of pregnancy). In parallel, the perinatal parameters of maternal and fetal health (including the risk of postpartum haemorrhage) were similar between the two groups of women.
Give the mother more time before you start pushing
These data show that increasing the time between the midwife’s observation of complete dilation of the cervix and the start of the pushing effort from 2 to 3 hours could make it possible to reduce the need for a medical intervention (use of forceps for example) or a emergency caesarean section. Moreover, this extension of the period would have no adverse effect on the health of the mother and the child.
Allowing the mother more time between full dilation of the cervix and the pushing effort could facilitate the second part of the delivery, facilitating the spontaneous expulsion of the child, without medical or surgical intervention. An important aspect to take into account in obstetrical practices, while the cesarean section rate is still high in France, compared to other Western countries.
Estelle B., Doctor of Pharmacy
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