How is second-stage of labor managed?

Updated: Jan 24, 2019
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

When the woman enters the second stage of labor with complete cervical dilatation, the fetal heart rate should be monitored or auscultated at least every 5 minutes and after each contraction during the second stage. [3] Although the parturient may be encouraged to actively push in concordance with the contractions during the second stage, many women with epidural anesthesia who do not feel the urge to push may allow the fetus to descend passively, with a period of rest before active pushing begins.

A number of randomized controlled trials have shown that, in nulliparous women, delayed pushing, or passive descend, is not associated with adverse perinatal outcomes or an increased risk for operative deliveries despite an often prolonged second stage of labor. [56, 57, 39] Furthermore, investigators who recently compared obstetric outcomes associated with coached versus uncoached pushing during the second stage reported a slightly shortened second stage (13 min) in the coached group, with no differences in the immediate maternal or neonatal outcomes. [58]

Le Ray et al reported that manual rotation of fetuses who were in occiput posterior or occiput transverse position at full dilatation was associated with reduced rates of operative delivery (ie, cesarean or instrumental vaginal delivery). [59, 60] In a study involving 2 French hospitals, operative delivery rates were significantly lower at the institution whose policy favored manual rotation than at the one that favored modification of maternal position (23.2% vs 38.7%), mainly because of lower rates of instrumental deliveries (15.0% vs 28.8%).


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