Rest and descend versus pushing with epidural anesthesia in the second stage of labor: maternal and fetal outcomes.

The study is a randomized, controlled, clinical trial of 167 women with epidural anesthesia comparing women who pushed immediately with those who had a period of rest and descend during the second stage of labor. Most of the data were collected using a computerized charting/fetal monitor. The dependent variables addressed are fetal descent, length of pushing, maternal fatigue, fetal decelerations, Apgar scores, arterial umbilical cord blood ph values, perineal injuries, and the type of delivery. The data were analyzed by parity group. The duration of the second stage of labor is lengthened when a period of rest and descend is used before pushing (p =.000). However, actual pushing time is decreased in primigravidas (p =.005) and in multigravidas (p =.001). Fetal well being, as reflected by Apgar scores and umbilical cord arterial ph values, is not significantly different. There are fewer mild variable decelerations in primigravidas (p =.000), and in multigravidas (p =.052).