Article: 'Coached' pushing offers little benefit

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Coached pushing offers little immediate benefit
Source: American Journal of Obstetrics and Gynecology 2006; 194: 10-3

Comparing obstetric outcomes with and without coached pushing during the second stage of labor.

Coached pushing during the second stage of labor offers no immediate benefits, apart from slightly speeding up the process, US researchers have found.

The benefits of routine coached pushing during the second stage of labor are being increasingly debated. Indeed, results of a previous randomized controlled trial by the research team found it to be associated with evidence of pelvic floor dysfunction 3 months after delivery.

To investigate the impact of such pushing on delivery and infant outcomes, Steven Bloom and colleagues (University of Texas Southwestern Medical Center, Dallas, USA) randomly assigned nulliparous women with straightforward labors and without epidural analgesia to perform coached (n = 163) or uncoached (n = 157) pushing during the second stage.

The duration of this stage of labor was shortened by approximately 13 minutes with coaching when compared to without it—a significant change—but no other clinically significant immediate maternal or neonatal outcomes were significantly affected, the team reports.

Summarizing their findings, the researchers write: "Although associated with a slightly shorter second stage, coached maternal pushing confers no other advantages and withholding such coaching is not harmful."

Indeed, "the short-term outcome findings that coached pushing confers neither benefit nor harm might be preempted if it is confirmed that coaching has deleterious long-term effects," they warn.

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Have I missed the point completely, but didn't they find they find a significant reduction in labour time with coached breathing? To me, this seems like a pretty good reason to have it, even if it didn't have an impact on pelvic floor dysfunction.

I'm not sure what you mean ms_fluffy, but what Kelly's referring to I think is also known as "Purple Pushing" and I have seen sooooo many birthing videos/shows etc where this is common (where you grunt and bear down like nothing else). And I've also watched where women go with the flow and breath down each contraction rather than purple push and the baby always seems (to me) to be born quicker and easier, and also easier on the mum too with less tearing etc.

I hope I'm on the right wavelength with both of you LOL!

But I know I'll be breathing down as oppose to purple pushing and if anyone tells me to push hard I'll tell them to shuttup! LOL!

*hugs*
Cailin

Just to clarify, second stage is pushing - often you will get an urge to push and working with this is fine. Pushing with a contraction is most effective but I think you are confusing it with breathing in labour and not pushing?