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Moms in Labor Can Take a Breather

Study encourages women to take breaks from pushing between stages

WEDNESDAY, Jan. 9, 2002 (HealthDayNews) -- In a break from the traditional approach to childbirth, a new study suggests there may no longer be a need for women to push continuously through the first and second stages of labor.

The research found that, for women who have epidurals, a period of rest between the first and second stages of labor not only helps Mom fight fatigue, it also doesn't harm the baby -- and may even contribute to a healthier birth.

The study appears in the January issue of the Journal of the American College of Obstetricians and Gynecologists.

"What this study demonstrated was that, once a woman is fully dilated, there is no harm to the baby if the pushing is preceded by a period of rest," says study author Dr. Steven Clark, professor of obstetrics and gynecology at the University of Utah Health Sciences Center.

There are two stages to labor; the first consists of a series of contractions that push the baby to the cervix, and the second stage begins when the baby enters the birth canal.

Although midwives have long advocated resting between labor stages, obstetricians traditionally have suggested continuous pushing, mostly to facilitate a quicker birth. However, doctors are now recommending that women take a breather between labor stages.

"It's called 'down laboring.' You allow the mother a period of up to one hour -- or as long as she can withstand the need to push -- while the baby's head descends on its own," says Dr. Michael Silverstein, assistant professor of obstetrics and gynecology at New York University Medical Center.

This, he says, allows the woman to save her energy for when it's really needed, "at the end of the labor, when you have to give that final push to deliver the baby," says Silverstein.

In addition, Clark reports that continuous pushing can sometimes contribute to "deceleration," a potentially dangerous slowing of the baby's heart rate and a problem that sometimes demands an immediate cesarean delivery.

"So, allowing mom a period of rest between labor stages may help baby as well," says Clark.

The new study included 252 pregnant women randomly assigned to either continuous pushing labor, or resting between labor stages. All the women received a pain-killing epidural anesthetic.

As labor proceeded, the Utah researchers monitored and recorded all variables, including the rate of fetal descent, the length of time required for pushing, and the number and type of fetal heart-rate decelerations.

The baby's health was also immediately recorded after birth, using a number of methods to assess neurological and other vital signs, including the traditional Apgar scores. Doctors also noted any birth injuries.

In addition, researchers recorded the type of delivery, the length of the second stage of labor, the level of maternal fatigue and any incidence of endometritis, an inflammation of the uterine lining.

The result: While the women who utilized the rest period did end up with a longer labor -- up to 4.9 hours -- nearly all said they felt better, with far less fatigue than the group that had shorter, but more arduous labors.

While the overall health of the infants in both groups was similar, doctors did record fewer decelerations of heartbeats in the group with mothers who rested between labor stages. In addition, the rate of endometritis was similar in both groups of women.

The bottom line, says Clark, is there were "no significant adverse outcomes -- for mother or baby -- in the group that rested between labor stages, and in fact, there were at least some advantages."

He does, however, warn that the technique is not right for every woman.

"If, for example, a woman were experiencing preeclampsia [pregnancy-related high blood pressure], or if infection was present, then a quick delivery would be to her best advantage. You would not want that resting period," he says.

Silverstein agrees: "This is particularly true if there is any fetal distress whatsoever, or any indication that a faster delivery would be beneficial for either mother or baby."

However, when both mother and baby are properly monitored throughout the labor, both experts say that a period of rest before delivery is a safe, common sense approach to labor.

What To Do: To learn lots more about labor, visit the American College of Obstetricians and Gynecologists. To learn more about epidural anesthesia and other pain relief options during pregnancy, visit the American Association of Nurse Anesthetists.

SOURCES: Interviews with Steven Clark, M.D., professor, obstetrics and gynecology, University of Utah Health Sciences Center, Salt Lake City; Michael Silverstein, M.D., associate professor, obstetrics and gynecology, New York University Medical Center, New York City; January 2002 The Journal of The American College of Obstetricians and Gynecologists
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