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This is the standard advice in many delivery rooms: do not push before the time runs out.
In general, mothers who give birth are ordered to wait until the midwife, doctor or birthing nurse indicates that the time has come – usually about an hour after dilation of the cervix uterus up to a certain diameter, often 10 centimeters.
Even the bible of many pregnant women – the book and the website "What to expect when one expects it to be" – suggests that women have to wait to push.
The common wisdom was that waiting made delivery easier and safer.
But a new study reverses this idea. It turns out that after the cervix expands to 10 centimeters, it is irrelevant that women are waiting to push or that they are advancing when they feel ready.
"Both approaches are commonly used and none are considered the absolute norm," said Dr. Alison Cahill of Washington University in St. Louis and her colleagues in their report.
But when women start pushing earlier, the total time of delivery tends to be shorter, report researchers in the Journal of the American Medical Association.
Many doctors have opted for a late approach when a large study conducted in the last century showed that delaying this push reduced the risk that the obstetrician would be forced to use a forceps to pull out the baby.
"Medio-pelvic forceps deliveries were prevalent 20 years ago when this study was conducted; however, these types of childbirth are obsolete in modern obstetric practice in the United States, "wrote Cahill and his colleagues.
Many doctors also thought that if women were slow to grow, there would be less need for Caesarean section.
The study of 2,400 women who give birth for the first time showed that delaying the push did not reduce the cesarean section rate. The women all had epidurals and were randomly assigned either to delay the push, or to continue and push when they felt like it, once they had reached 10 cm apart.
In both groups, about 85% of babies gave birth without surgery. There was no significant difference in the risk of hemorrhage between groups.
But rates of some rare complications were lower in the group of women who were allowed to push when they wanted to. Babies were less likely to suffer from high levels of acid in their blood, making it difficult to stay without oxygen for too long. They were also less likely to develop chorioamnionitis, a complication caused by the forced introduction of bacteria into the uterus during prolonged labor.
And the researchers found that the overall duration before birth was on average 30 minutes shorter when women were allowed to grow earlier.
"The results clearly demonstrate that, for the vast majority of new mothers under epidural anesthesia, delaying relapses provides no benefit compared to immediate second-stage seizures," said Dr. Menachem Miodovnik of the National Institute. of infant health. Human development, which financed the study.
Jeffrey Sperling and Dana Gossett, of the University of California at San Francisco, did not participate in the study.
"Nearly 4 million births occur each year in the United States, of which about 68% involve vaginal delivery. It is therefore essential to have additional evidence to guide the management of work, "they wrote in a comment.
There is probably no specific time when it is better to start lobbying, they said.
Now, they said, it will be important to conduct a similar study among women giving birth for the second or third time.
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