To push or not to push? For first-time moms who opt for an epidural during labor, you should begin pushing immediately after the cervix is fully dilated (to around 10 centimeters), according to a 2018 study of more than 2,400 women published in the Journal of the American Medical Association.
Previously, obstetricians advised patients to delay pushing for one hour after dilation. The rationale was that the baby would position itself and make progress on its own, and mom wouldn’t have to work as hard. However, this study shows that immediate pushers shortened the second stage of labor by more than a half hour.
It was also thought that waiting to push would decrease the need for forceps and cesarean section. However, the rate of forceps use has dropped spontaneously, and this study determined that delayed pushing over immediate pushing did not reduce the risk of C-section. In the United States, the rate of C-sections has increased from 20 percent to 30 percent in the past 25 years,in part due to the increase in elective procedures. The medical community is making an effort to reduce that number, however, through technological advancements and patient education, because C-sections area major abdominal surgery with all associated surgical risks.
Delayed pushing can increase the risk of infections associated with prolonged labor, as well as maternal hemorrhaging. Also, babies are more likely to experience acidemia, or high levels of blood acid, a complication of prolonged lack of oxygen.
Unfortunately, immediate pushing did show a slight increase in third-degree perineal tearing.
Because the adverse results for delayed pushing can lead to serious complications, immediate pushing will now be considered safer for first-time moms receiving epidurals and their babies. Further studies are needed for women giving birth to their second child and beyond.