Delayed pushing Versus Coached Pushing

Delayed pushing Versus Coached Pushing

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Delayed pushing Versus Coached Pushing

Delayed pushing refers to the attempt to let down in a mother who is in labor during the process of giving birth and not pushing initially. Delayed pushing is when the woman is given instructions to avoid pushing until the urge to push is irresistible or until the baby has descended to the perineum. Coached or purple pushing refers to the process when women are trained by a medical personnel on how to push and let down the baby. Pushing is done during the second stage of labor, after full dilatation of the cervix at ten centimeters.

Delayed pushing entails whereby the mother takes time before attempting to apply muscular force with the help of the abdominal muscles. The uterus contracts in sequences and applies force to aid the baby to come out. In the meantime, the mother is stimulate to apply valsalva maneuvers in order to try and add to the effort of giving birth. In delayed pushing, the mother awaits for some period of time before starting to push and giving the valsalva maneuvers. The delayed pushing might be done with or without epidural method of anesthesia.

Coached pushing the pregnant women are asked to lie in specific positions and taught by the medical personnel or trainer on how to push and for how long to push. The assistant gives the mother moral support to continue pushing when required. Normally, the women are taught to put their chin to their chest, holding their breath for a count of 10 seconds and pushing as hard as they can several times during contractions. The women are trained and coached with or without the help of epidural anaesthesia. The training is usually on a time limit because too much laboring on second stage of laboring might cause complications.

A review of randomized clinical trials concluded that coached pushing, as a method of giving birth is not recommended. The review recommended that supporting spontaneous pushing and encouraging women to decide on what method of pushing they prefer was the best clinical practice during the stages of labor. Evidence also showed that it was better to delay pushing for several hours than to put the mother under training of coached pushing. It was encouraged that it was better for the mother to delay until the urge to push and let down is felt. Delayed pushing was not associated with demonstrable complications despite the second stage of labor going on up to 4.9 hours. In select patients, such delay may be beneficial.

In terms of amount of time a woman pushes, coached pushing shows slight reduction compared to delayed pushing. However, coached pushing causes increased stress on the baby and increases incidents of late decelerations in the baby’s heart rates. Coached pushing also causes the baby to receive low oxygen levels and it increases fatigue in mothers. There is increased organ injury to the baby and low Apgar score for babies with coached pushing. Coached pushing causes great discomfort and pain to mothers. Delayed pushing was associated with increased time during the second stage of labor. Delayed pushing reduced incidents of organ injury and it helped the mother to give birth in their most favorable position with reduced pain of contractions. Delayed pushing was associated with reduced perineum injury and reduced pelvic floor injury.

From reviews of a total of 20 included studies by Cochrane, with studies of mixed methodology, in terms of perineal lacerations, there was no difference between delayed and coached pushing. There was also no difference in the incidences of episiotomy. However, there is insufficient evidence to conclude and justify the routine use of a certain or specific timing of pushing, this is because the benefits arising from the various kinds of pushing and the adverse effects are not well established and concluded therein.