Do maternal pushing techniques during labour affect obstetric or neonatal outcomes?

Abstract

Objectives: To assess, through a literature review, the maternal and neonatal morbidity associated with the type of pushing used during the second stage of labour.

Methods: We searched the Cochrane Library and the Medline database for randomised controlled trials from 1980 to 2015, using the following keywords: "delivery", "birth", "birthing", "bearing down, coached, uncoached, pushing", "second and stage and labour", "randomised controlled trials" and "meta-analysis".

Results: Seven randomised controlled trials were found. Interventions varied between the studies. In the intervention groups, open-glottis pushing was spontaneous or coached. The groups did not differ for perineal injuries, episiotomies or type of birth. Impact on pelvic floor structure varied between the studies. Only one study found a better 5-minute Apgar score and a better umbilical artery pH in the "open glottis" group.

Conclusion: The low methodological quality of the studies and the differences between the protocols do not justify a recommendation of a particular pushing technique. Further studies appear necessary to study outcomes with each of these techniques.

Keywords: Coached pushing; Déchirure périnéale; Morbidité néonatale; Neonatal morbidity; Perineal injuries; Poussée dirigée; Pushing techniques; Second stade du travail; Second stage of labour; Type de poussée.