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A randomized trial of coached versus uncoached maternal pushing during the second stage of labor.

Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

OBJECTIVE: The objective of this study was to compare obstetrical outcomes associated with coached versus uncoached pushing during the second stage of labor. STUDY DESIGN: Upon reaching the second stage, previously consented nulliparous women with uncomplicated labors and without epidural analgesia were randomly assigned to coached (n = 163) versus uncoached (n = 157) pushing. Women allocated to coaching received standardized closed glottis pushing instructions by certified nurse-midwives with proper ventilation encouraged between contractions. These midwives also attended those women assigned to no coaching to ensure that any expulsive efforts were involuntary. RESULTS: The second stage of labor was abbreviated by approximately 13 minutes in coached women (P = .01). There were no other clinically significant immediate maternal or neonatal outcomes between the 2 groups. CONCLUSION: Although associated with a slightly shorter second stage, coached maternal pushing confers no other advantages and withholding such coaching is not harmful.

Published 3 January 2006 in Am J Obstet Gynecol, 194(1): 10-3.
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