Don't Delay After Dilation To Push Baby Out : Shots - Health News There's no benefit to delaying pushing after receiving epidural anesthesia and reaching full dilation. A delay increases the risk of complications, particularly for the mother, a large study finds.

When Giving Birth For The First Time, Push Away

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A new study looking at childbirth for first-time mothers finds that a common practice is risky. It found that waiting to push the baby down the birth canal can be dangerous for both the mother and the baby. NPR's Patti Neighmond reports on the study in the Journal of the American Medical Association.

PATTI NEIGHMOND, BYLINE: If you're a first-time mom and have epidural anesthesia during labor, your natural instinct to push is suppressed. Obstetrician-gynecologist Dr. Alison Cahill of Washington University in St. Louis...

ALISON CAHILL: That gives them pain relief, but it also numbs some of those reflexes. And women most typically do not instinctively start pushing to deliver the baby.

NEIGHMOND: In fact, doctors often coach new mothers to wait about an hour before starting to push, giving them a rest and, the thinking goes, making vaginal delivery more likely and reducing the chance of having a C-section. Cahill wanted to test that theory. She enrolled more than 2,400 first-time mothers in her study. Half were randomly assigned to push immediately after their cervix was completely dilated. The other half waited 60 Minutes.

CAHILL: Neither strategy increased the chance of a spontaneous vaginal delivery.

NEIGHMOND: So when it came to having a vaginal delivery, it didn't make any difference whether women pushed immediately or waited. And Cahill found some unexpected downsides to waiting.

CAHILL: Women in the delayed group had an increased risk of having significant bleeding or a postpartum hemorrhage at the time of delivery as well as having an increased risk of infection.

NEIGHMOND: Excessive bleeding and infection can be serious, even life-threatening, she says, for mother and baby.

CAHILL: Women who pushed immediately had a 40 percent reduction in their risk of having a hemorrhage or bleeding - significant bleeding. And they had a 30 percent reduction in the chance of developing an infection.

NEIGHMOND: So the clear take-home message here - once the cervix is dilated, start pushing. You'll likely have a successful vaginal delivery. Cahill says the findings of the study should upend the practice of waiting to push. In fact, ACOG, the American College of Obstetricians and Gynecologists, is changing its advice for doctors and now has a new message for first-time moms. ACOG official Dr. Christopher Zahn...

CHRISTOPHER ZAHN: Delaying pushing will not increase your odds of having a vaginal delivery as opposed to a cesarean delivery. And on top of that, there is increased risk to you, or the mom.

NEIGHMOND: In an editorial published with the study, obstetrician-gynecologist Dana Gossett of the University of California, San Francisco says any effort to avoid cesarean section is worthwhile.

DANA GOSSETT: While a cesarean is a delivery; it is a birth, it's also a major abdominal surgery. It comes with a lot of risks that don't apply when we think about a normal vaginal delivery. Those risks include increased bleeding, blood transfusion, damage to other organs, particularly the bladder, risk of hysterectomy, increased risk of infection. And there's even an increased risk of death from a cesarean.

NEIGHMOND: Gossett notes the rate of C-sections in the U.S. and around the world has shot up in recent years. As it is now, C-sections account for about one-third of all births in the U.S. Patti Neighmond, NPR News.


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