3.1. Initiation of active pushing
A woman should be encouraged to push when full cervical dilatation,
the fetal condition, and engagement of the presenting part have
been confirmed, and the woman feels an urge to bear down. Even
when the woman feels the urge, pushing should only be encouraged
during a contraction [4]. In the absence of the urge to push and in
the presence of a normal fetal heart rate, care providers should wait
before encouraging active pushing in primiparous women and
women who have had an epidural for up to but not longer than
4 hours, and in multiparous women for up to but not longer than
1 hour [5,6]. The basis for this recommendation is that under normal
circumstances at the end of the first stage of labor, uteroplacental perfusion
and fetal oxygenation only start to deteriorate once active
pushing commences.
3.2. Duration of active pushing in the second stage of labor
Primiparous women should not actively push for more than
2 hours and multiparous women for more than 1 hour, owing to an
increased risk of birth asphyxia and maternal infection [7]. Lack of descent
of the presenting part may also indicate obstructed labor.
Intervention should be considered promptly and options evaluated
and acted upon before these indicative time periods if the maternal
and/or fetal condition deviates from normal; for example, in the
presence of fetal bradycardia or severe maternal hypertension.
3.1. Initiation of active pushingA woman should be encouraged to push when full cervical dilatation,the fetal condition, and engagement of the presenting part havebeen confirmed, and the woman feels an urge to bear down. Evenwhen the woman feels the urge, pushing should only be encouragedduring a contraction [4]. In the absence of the urge to push and inthe presence of a normal fetal heart rate, care providers should waitbefore encouraging active pushing in primiparous women andwomen who have had an epidural for up to but not longer than4 hours, and in multiparous women for up to but not longer than1 hour [5,6]. The basis for this recommendation is that under normalcircumstances at the end of the first stage of labor, uteroplacental perfusionand fetal oxygenation only start to deteriorate once activepushing commences.3.2. Duration of active pushing in the second stage of laborPrimiparous women should not actively push for more than2 hours and multiparous women for more than 1 hour, owing to anincreased risk of birth asphyxia and maternal infection [7]. Lack of descentof the presenting part may also indicate obstructed labor.Intervention should be considered promptly and options evaluatedand acted upon before these indicative time periods if the maternaland/or fetal condition deviates from normal; for example, in thepresence of fetal bradycardia or severe maternal hypertension.
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