A Meta-Analysis of Passive Descent Versus Immediate Pushing in Nulliparous Women With Epidural Analgesia in the Second Stage of Labor
Version of Record online: 22 JAN 2008
2008, AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Volume 37, Issue 1, pages 4–12, January/February 2008
How to Cite
Brancato, R. M., Church, S. and Stone, P. W. (2008), A Meta-Analysis of Passive Descent Versus Immediate Pushing in Nulliparous Women With Epidural Analgesia in the Second Stage of Labor. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37: 4–12. doi: 10.1111/j.1552-6909.2007.00205.x
- Issue online: 22 JAN 2008
- Version of Record online: 22 JAN 2008
- Accepted October 2007
- second stage;
- passive descent laboring;
- downrest and descend;
- physiologic second stage
Objective: To determine which method of pushing—passive descent or early pushing—most benefits women with epidurals during second-stage labor.
Data sources: MEDLINE, CINAHL, and Cochrane Database.
Study selection: Studies limited to randomized controlled trials in English, comparing passive descent to early pushing in women with effective epidural analgesia.
Data extraction: A hand search was performed. Data included number of instrument-assisted deliveries (forceps and vacuum); noninstrumental or spontaneous vaginal births, cesarean births, pushing time, episiotomies, lacerations; maternal fatigue; and fetal well-being.
Data synthesis: Seven studies were eligible for a sample size of 2,827 women. Pooled data indicate that passive descent increases a woman’s chance of having a spontaneous vaginal birth (relative risk: 1.08; 95% confidence interval: 1.01-1.15; p = 0.025), decreases risk of having an instrument-assisted deliveries (relative risk: 0.77; 95% confidence interval: 0.77-0.85; p ≤ 0.0001), and decreases pushing time (mean difference: −0.19 hours; 95% confidence interval: −0.27 to −0.12; p ≤ 0.0001). No differences were found in rates of cesarean births (relative risk: 0.80; 95% confidence interval: 0.57-1.12; p = 0.19), lacerations (relative risk: 0.88; 95% confidence interval: 0.72-1.07; p = 0.20), or episiotomies (relative risk: 0.97; 95% confidence interval: 0.88-1.06; p = 0.45).
Conclusions: Significant positive effects were found indicating that passive descent should be used during birth to safely and effectively increase spontaneous vaginal births, decrease instrument-assisted deliveries, and shorten pushing time.