When you give birth for the first time, push back

If you are a first-time mother and opt for epidural anesthesia during labor, your doctor may suggest that you wait about an hour after complete dilation of your cervix before starting to push the baby into the uterine canal.

But a study published Tuesday in JAMA, The flagship journal of the American Medical Association suggests that this might not be the best advice.

"Our findings suggest that women who become mothers for the first time should start pushing as soon as they are fully dilated, to achieve the best results for themselves and for their babies," said the obstetrician. Alison G. Cahill of Washington University in St. Louis. led the study.

Until now, evidence to support one or the other method was mixed, explains Cahill. As a result, tips on when to push are about 50-50, she says.

One school of thought encourages women to push immediately after cervical dilatation, the other says, "Wait, take the time." As a general rule, this means waiting about an hour after complete dilation of the cervix.

"It was thought that women may not need to do as much effort to get the baby out and that the baby would make progress without these efforts," explains Cahill. It was also thought that delaying the push could increase the chances of a healthy vaginal delivery and avoid forceps or cesarean section – and even shorten the time to delivery.

But that was not the case. Delaying postponement made no difference as to whether women had a caesarean section or not, she says.

The study was conducted at six US medical centers with 2414 women aged 37 weeks or older. Their average age was 26.5 years old. Women had not yet given birth.

They were randomly assigned to one of two groups once they reached full cervical dilatation. Half was told to start pushing immediately; we asked the other half to wait an hour.

All women received painkillers for labor and delivery.

Delaying the push has had adverse consequences. Four percent of the women who were waiting to push had excessive bleeding after delivery, compared to 2.3% who were growing right away. Delayed outbreaks had more bacterial infections: 9.1% versus 6.7% of women who grew immediately.

Cahill says that these reductions of the adverse consequences of an immediate surge are significant because the infection can be serious and even life-threatening for the mother and the baby.

And there was another advantage to push right away. "The second phase of women's work that immediately grew was going a little over half an hour faster," says Cahill, "and this second, shorter phase of work is healthier for both mothers and babies. "

Dr. Christopher Zahn, vice president of practice activities at the American College of Obstetricians and Gynecologists, states that the message to remember is clear: there is no significant benefit to delaying and delaying 39, increased risk of adverse events, especially for mothers.

"This is a very well done study with a large number of patients," Zahn said.

According to Zahn, the college's practice guidelines will be updated based on these findings to inform doctors that delayed breakouts will not increase the chances of normal vaginal delivery and, in addition, that the risk of "unwanted problems for mom" increases.

The findings and new guidelines come at a time when the medical community is strongly encouraging vaginal deliveries over caesareans, which can have many negative consequences for women and babies.

A cesarean is a "major abdominal operation," says Dr. Dana Gossett, director of general obstetrics and gynecology at the University of California at San Francisco. Risks include "increased bleeding, blood transfusions, damage to other organs, especially the bladder, internal scarring, risk of hysterectomy, risk of infection and even a risk of infection. increased risk of death. "

In an editorial accompanying the study, Gossett considers these results as an important contribution to the management of labor and deliveries in an "evidence-based" manner while not endangering the health of the mother or fetus.

Any practice that can reduce the number of cesarean deliveries, she says, is worth it, especially since the cesarean section rate has "really exploded, not just in the United States, but around the world." integer ".

Every year in the United States, there are nearly 4 million births. About a third are cesarean deliveries.

Copyright NPR 2018.