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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(02): e183-e186
DOI: 10.1055/s-0040-1709982
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Redefining Second Stage of Labor: Number of Pushing Contractions

Serin M. Bok
1   Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
,
Gabriela E. Pena Carmona
1   Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
,
Jake Crawford
1   Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
,
Ramy Eskander
1   Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
,
Mina Desai
1   Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
,
Michael G. Ross
1   Department of Obstetrics and Gynecology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California
› Author Affiliations
Further Information

Publication History

04 July 2019

10 November 2019

Publication Date:
19 June 2020 (online)

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Abstract

Introduction Despite time standards for second stage labor, “delayed pushing,” uterine contraction frequency, and alternate contraction pushing may alter the effective maternal effort. We sought to quantify the number of pushing contractions needed for a spontaneous vaginal delivery (SVD) among primipara and multipara patients.

Methods Deliveries at Harbor-UCLA Medical Center in 2017 were selected for SVD of singleton, term newborns. The first 100 primipara and 100 multipara deliveries were analyzed and monitor tracings quantified for pushing contractions.

Results Significantly more pushing contractions were required by primiparas versus multiparas (17.3 ± 1.7 vs. 5.5 ± 0.7; p < 0.001) in accord with a longer second stage (86.7 ± 7.8 vs. 27.2 ± 4.9 min; p < 0.001) and epidural was associated with greater number of pushing contractions among both primipara (18.5 ± 1.8 vs. 10.8 ± 0.8) and multipara women (6.1 ± 0.8 vs. 4.1 ± 0.3). Newborn weight (<3000, 3000–3500, >3500 g) demonstrated a trend for increased pushing contractions among primipara (16.9, 16.5, 19.8 pushes, respectively) though not multiparas.

Conclusion Although correlated with the absolute duration of the second stage, the number of pushing contractions eliminates ambiguities of “delayed pushing,” pushing every-other, and frequency of contractions. Examination of larger databases and patients with second stage “arrest disorders” may provide pushing contraction criteria predictive of SVD and prevention of morbidity.

Keywords

Labor - pushing - second stage - duration
 

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