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Created on : 01 Apr 2005
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

The "push" for evidence: management of the second stage. J Midwifery Womens Health. 2002 Jan-Feb;47(1):2-15.

Author(s) :

Roberts JE.

Year of publication :

2002

URL(s) :

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=…

Résumé (français)  :

Abstract (English)  :

Recognition that the available evidence does not support arbitrary time limits for the second stage of labor has led to reconsideration of the influence of maternal bearing down efforts on fetal/newborn status as well as on maternal pelvic structural integrity. The evidence that the duration of ’active’ pushing is associated with fetal acidosis and denervation injury to maternal perineal musculature has contributed to the delineation of at least two phases during second stage, an early phase of continued fetal descent, and a phase of "active" pushing. The basis for the recommendation that the early phase of passive descent be prolonged and the phase of active pushing shortened by strategies to achieve effective, but non-detrimental pushing efforts is reviewed. The rational includes an emphasis on the obstetric factors that are optimal for birth and conducive to efficient maternal bearing down. Explicit assessment of these obstetric factors and observation of maternal behavior, particularly evidence of an involuntary urge to push, should be coupled with the use of maternal positions that will promote fetal descent as well as reduce maternal pain. The use of epidural analgesia for pain relief can also be accompanied by these same principles, although further research is needed to verify the strategies of "delayed pushing" and maintenance of pain relief along with a reconceptualization of the second stage of labor.

Sumário (português)  :

Resumen (español)  :

Full text (private) :

Comments :

Argument (français) :

Revue des facteurs obstétriques optimaux pendant le second stade, en particulier les positions de la femme et le réflexe de poussée. Réflexion sur ces facteurs en cas de péridurale.

Argument (English):

Argumento (português):

Argumento (español):

Keywords :

➡ evidence-based medicine/midwifery ; position during labor ; physiology ; perineal/vaginal tears ; fetal distress ; epidural

Author of this record :

Cécile Loup — 01 Apr 2005