NEW YORK (Reuters Health) - Allowing a period of rest before pushing is safe and even beneficial for many women and fetuses during labor, Utah researchers report in the January issue of Obstetrics & Gynecology.

Studies on whether women under epidural anesthesia should begin pushing once their cervix has completely dilated or wait to allow the fetus to descend on its own have had conflicting results. To settle the debate, Dr. Susan L. Hansen and colleagues from Intermountain Health Care in Salt Lake City randomly assigned 252 women to either begin pushing immediately after complete dilation or to rest to allow passive descent of the fetus. All of the women had epidural anesthesia, an injection of medication into the membrane surrounding the spine that numbs the body below the waist.

Newborns of women allowed a period of rest had slightly better Apgar scores--a test used to measure the health of the baby at birth--than the women who started pushing immediately, but the difference was not statistically significant.

While the second stage of labor--which begins once the cervix has opened completely--was longer in the women who rested, their pushing time was decreased and there were fewer cases of slowed fetal heart rate. Among woman having their first child, those who rested were also less fatigued.

The effect on fatigue may be even greater than the results suggest, the authors note, because it was measured directly after the women gave birth, when the new mothers felt ``the natural euphoria of many such women after having given birth to their first child.

``Thus, the actual beneficial effects may be even greater than we were able to assess,'' they write.

Hansen and colleagues note that American College of Obstetricians and Gynecologists (ACOG) recommends the second stage of labor in women given epidural anesthesia not exceed 2 hours in women who have already had children and 3 hours in women giving birth for the first time. While a delayed push protocol may prolong the second stage beyond the ACOG guidelines, the researchers say, it may be appropriate for certain women, including those who are too fatigued to push effectively.

SOURCE: Obstetrics & Gynecology 2002;99:29-34.

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