February 27, 2014 — The second stage of labor -- known as the "pushing" stage -- can be significantly longer than traditionally estimated, especially when an epidural is used, according to a recent study in Obstetrics & Gynecology.
The findings suggest that in healthy pregnancies, many women and their doctors can safely wait longer before considering a caesarean section, forceps delivery or other interventions.
University of California-San Francisco researchers reviewed records on more than 42,000 women who had vaginal deliveries without complications between 1976 and 2008. About half of the women had epidurals, which are known to lengthen the second stage of labor.
The researchers calculated the upper limits of labor durations for women who had epidurals and those who did not (Saint Louis, New York Times, 2/5).
Last week, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine released new guidelines that updated recommendations on when ob-gyns should consider interventions during labor for low-risk pregnancies. The groups said that outdated conventions on how long doctors should let women labor could be contributing to high c-section rates.
Under the new guidelines, doctors should allow women to push for at least three hours during their first time giving birth and at least two hours during subsequent births, unless the woman is too tired. ACOG and SMFM said women who have had an epidural can push even longer if the doctor can see progress (AP/Washington Post, 2/19).