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.