Among the prespecified exploratory outcomes, the rates of neonatal acidemia and suspected neonatal sepsis were significantly higher in the delayed pushing group. In contrast, the rate of third-degree perineal lacerations was significantly higher in the immediate pushing group.
01. Discussion: Delayed pushing results in less fetal oxygen desaturation and less > or =2-min epochs of fetal oxygen saturation <30% during second-stage labor than the immediate pushing method; thus, delayed pushing is more favorable for fetal well-being as measured by fetal oxygen saturation.
A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period.
Prolonged labor during the second stage is more serious because it increases the risk of: Infection. Postpartum hemorrhage. Future incontinence.
Suspect delay if progress, in terms of descent and/or rotation of the presenting part, does not occur after 1 hour of active second stage. Suspect delay if progress, in terms of descent and/or rotation of the presenting part, does not occur after 30 minutes of active second stage.
Maternal risk factors associated with a prolonged second stage include nulliparity, increasing maternal weight and/or weight gain, use of regional anesthesia, induction of labor, fetal occiput in a posterior or transverse position, and increased birthweight.
When there is a prolonged deceleration phase, progress in dilation slows after 8 cm and uterine contractions become dysfunctional, even after oxytocin administration. In this situation, the cervix starts to swell and take on fluid. In this situation, a C-section may be needed.
What happens in the second stage of labor? In the second stage of labor, your cervix is fully dilated and ready for childbirth. This stage is the most work for you because your provider wants you to start pushing your baby out. This stage can be as short as 20 minutes or as long as a few hours.
The second stage of labour is when the pushing happens and your baby is born. This stage begins when the neck of the womb (cervix) is fully open and lasts until the birth of your baby. It can take 1–2 hours to push out your first baby.
If a baby is overdue, the main associated risks are: The placenta might gradually stop being able to do its job properly. An infection might develop inside the womb. Unexpected problems might arise during labor.
Major risk factors associated with a prolonged passive second stage were maternal age ≥ 30 years, epidural analgesia, malpresentation and birthweight ≥ 4 kg. High BMI and noncohabiting during pregnancy were associated with a reduced risk.
Postponing childbirth to age 35 years and later increased the risk of rare but serious pregnancy outcomes, such as stillbirth and very preterm birth. Older first-time parents were slightly more anxious during pregnancy, and childbirth overall was experienced as more difficult, compared with younger age groups.
Laboring down is the practice of not pushing for one to two hours immediately after the second stage of labor begins. It may help your baby descend into the birth canal more naturally and reduce the overall time you have to push. But studies suggest delayed pushing could pose some health risks to you and your baby.
The 2 most common approaches to the second stage of labor management are to either initiate pushing with uterine contractions once complete cervical dilation occurs (immediate pushing) or to allow for spontaneous descent (delayed pushing).
The most common cause of fetal distress is the fetus not getting enough oxygen. The fetus gets oxygen from you. You breathe oxygen into your lungs, then your blood carries it to the placenta.
The factors prolonging the duration of the second stage of labor contain age (over 30 years old), height (<155 cm), BMI (>28), body weight gaining during pregnancy (>8.0 kg), fetal position in the first stage of labor (ROT), and fetal membrane condition (ruptured) for all of primipara and multipara.
[1] This triad is classically referred to as the passenger, power, and passage. [1] Clinicians typically use multiple modalities to monitor labor. Serial cervical examinations are used to determine cervical dilation, effacement, and fetal position, also known as the station.
A number of features are typical of the mother's behaviour during the second stage: she may feel a spurt of energy or 'second wind' she is likely to feel calmer, and the sense of purpose that she may have experienced earlier may return. she will need physical help and support.
The levatoani muscles dilate, thin out and are displaced laterally and the perineal body is flattened, stretched and thinned. The fetal head becomes visible at the vulva, advancing with each contraction and receding between contractions until crowning takes place.
Late decelerations are dangerous because they are evidence of uteroplacental insufficiency. The placenta is the fetus' lifeline from the mother. Vital blood and oxygen flow from the mother's uterus to the placental and into the umbilical cord to the fetus.
Late decelerations are one of the precarious decelerations among the three types of fetal heart rate decelerations during labor. They are caused by decreased blood flow to the placenta and can signify an impending fetal acidemia.
A prolonged deceleration may signal danger—or reflect a perfectly normal fetal response to maternal pelvic examination. Because of the wide range of possibilities, this fetal heart rate pattern justifies close attention. For example, repetitive prolonged decelerations may indicate cord compression from oligohydramnios.
Delayed pushing had some adverse consequences. Four percent of women who waited to push had excessive bleeding after delivery compared with 2.3 percent who pushed right away. The delayed pushers had more bacterial infections: 9.1 percent versus 6.7 percent of the women who pushed immediately.
Pushing during the second stage of normal labor has no positive benefits for either mother or baby. When the mother is pushing forcefully, she is holding her breath and bearing down. When she holds her breath, she temporarily stops the oxygen flowing around her body, and to the baby inside.