Pushing/bearing down methods for the second stage of labour

Cochrane Database of Systematic Reviews

Volumn 2017, Issue 3, 2017, Pages

  Lemos, Andrea ^a   Amorim, Melania Mr ^b   Dornelas de Andrade, Armele ^a   de Souza, Ariani I ^b   Cabral Filho, José Eulálio ^b   Correia, Jailson B ^b  

^a FEDERAL UNIVERSITY OF PERNAMBUCO   (Brazil)

^b INSTITUTO DE MEDICINA INTEGRAL PROF FERNANDO FIGUEIRA   (Brazil)

Author keywords

[No Author keywords available]

Indexed keywords

APGAR SCORE; CESAREAN SECTION; DYSPAREUNIA; EPISIOTOMY; FATIGUE; FECES INCONTINENCE; HEALTH CARE COST; HUMAN; INSTRUMENTAL DELIVERY; INTERMETHOD COMPARISON; LABOR STAGE 2; NEWBORN INTENSIVE CARE; OUTCOME ASSESSMENT; OVERACTIVE BLADDER; PATIENT SATISFACTION; POSTPARTUM HEMORRHAGE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; STRESS INCONTINENCE; SYSTEMATIC REVIEW; UMBILICAL CORD; VAGINAL DELIVERY; ADULT; BREATH HOLDING; BREATHING; EPIDURAL ANALGESIA; FEMALE; INJURIES; META ANALYSIS; NEONATAL INTENSIVE CARE UNIT; NEWBORN; OBSTETRIC ANALGESIA; OBSTETRIC DELIVERY; PERINEUM; PHYSIOLOGY; PREGNANCY; PROCEDURES; PUBLISHING; TIME FACTOR; UTERUS CONTRACTION; UTILIZATION; VALSALVA MANEUVER;

ADULT; ANALGESIA, EPIDURAL; ANALGESIA, OBSTETRICAL; BREATH HOLDING; DELIVERY, OBSTETRIC; FEMALE; HUMANS; INFANT, NEWBORN; INTENSIVE CARE UNITS, NEONATAL; LABOR STAGE, SECOND; PERINEUM; PREGNANCY; PUBLICATION BIAS; RANDOMIZED CONTROLLED TRIALS AS TOPIC; RESPIRATION; TIME FACTORS; UTERINE CONTRACTION; VALSALVA MANEUVER;

EID: 85016278232     PISSN: None     EISSN: 1469493X     Source Type: Journal    
DOI: 10.1002/14651858.CD009124.pub3     Document Type: Review

References (105)

1. Buxton EJ, Redman CWE, Obhari M. Delayed pushing with lumbar epidural in labour- does it increase the incidence of spontaneous delivery?. Journal of Obstetrics and Gynaecology 1988;8:258-61. 2924126
2. Buxton EJ, Redman CWE, Obhrai M. Delayed pushing in the second stage: effect on fetal acid base status. Proceedings of Silver Jubilee British Congress of Obstetrics and Gynaecology; 1989 July 4-7; London, UK. 1989:80. 2924127
3. Fitzpatrick M, Harkin R, McQuillan K, ÓBrien C, ÓConnell PR, ÓHerlihy C. A randomised clinical trial comparing the effects of delayed versus immediate pushing with epidural analgesia on mode of delivery and faecal continence. BJOG: an international journal of obstetrics and gynaecology 2002;109:1359-65. 2924129
4. Fitzpatrick M, O'Brien C, McQuillan K, O'Connell PR, O'Herlihy C. Comparison of immediate and delayed pushing in second stage of labor on anal sphincter integrity and mode of delivery. American Journal of Obstetrics and Gynecology 2000;182(1 Pt 2):S37. 2924130
5. Fraser WD, Marcoux S, Douglas J, Goulet C, Krauss I, for the PEOPLE Study Group. Multicentre trial of delayed pushing for women with continuous epidural. Acta Obstetricia et Gynecologica Scandinavica 1997;76 Suppl(167:1):45. 2924132
6. Fraser WD, Marcoux S, Douglas J, Goulet C, Krauss I, for the PEOPLE Study Group. Multicentre trial of delayed pushing for women with continuous epidural. Society of Obstetricians and Gynaecologists of Canada, 54th Annual Meeting; 1988 June; Victoria, Canada. 1998:36. 2924133
7. Fraser WD, Marcoux S, Krauss I, Douglas J, Goulet C, Boulvain M, for the PEOPLE (Pushing Early or Pushing Late with Epidural) Study Group. Multicenter randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labor with continuous epidural analgesia. American Journal of Gynecology and Obstetrics 2000;182(5):1165-72. 2924134
8. Le Ray C, Audibert F, Goffinet F, Fraser W. When to stop pushing? Consequences of pushing duration on maternal and neonatal outcomes in nullipara with epidural. American Journal of Obstetrics and Gynecology 2008;199(6 Suppl 1):S37. 2924135
9. Le Ray C, Audibert F, Goffinet F, Fraser W. When to stop pushing? effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparas women with epidural analgesia. American Journal of Obstetrics and Gynecology 2009;201:361.e1-361.e7. 2924136
10. Lin P, Newton W. Does delayed pushing reduce difficult deliveries for nulliparous women with epidural analgesia?. Journal of Family Practice 2000;49(9):783-4. 2924137
11. Petrou S, Coyle D, Fraser WD, for the PEOPLE (Pushing Early or Pushing Late with Epidural) study group. Cost-effectiveness of a delayed pushing policy for patients with epidural anesthesia. American Journal of Obstetrics and Gynecology 2000;182(5):1158-64. 2924138
12. Gillesby E, Burns S, Dempsey A, Kirby S, Mogensen K, Naylor K, et al. Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia. Journal of Obstetric, Gynecologic and Neonatal Nursing 2010;39(6):635-44. 2924140
13. Gillesby EJ, Mogensen KD, Burns SM, Kirby S, Naylor KS, Petrella JA, et al. Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia. JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2010;39 Suppl 1:S87. 2924141
14. Goodfellow CF, Studd C. The reduction of forceps in primigravidae with epidural analgesia-a controlled trial. British Journal of Clinical Practice 1979;33(10):287-8. 2924143
15. Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstetric & Gynecology 2002;99(1):29-34. 2924145
16. Jahdi F, Shahnazari M, Kashanian M, Farahani MA, Haghani H. A randomized controlled trial comparing the physiological and direct pushing on the duration of the second stage of labor, the mode of delivery and Apgar score. International Journal of Collaborative Research on Internal Medicine & Public Health 2011;3(2):159-64. 2924147
17. Jahdi F, Shahnazari M, Kashanian M, Farahani MA, Haghani H. A randomized controlled trial comparing the physiological and directed pushing on the duration of the second stage of labor, the mode of delivery and Apgar score. International Journal of Nursing and Midwifery 2011;3(5):55-9. [ISSN 2141-2499]5312624
18. Kelly M, Johnson E, Lee V, Massey L, Purser D, Ring K, et al. Delayed versus immediate pushing in second stage of labor. MCN; American Journal of Maternal Child Nursing 2010;35(2):81-8. 2924149
19. Knauth DG, Haloburdo EP. Effect of pushing techniques in birthing chair on length of second stage of labor. Nursing Research 1986;35:49-51. 2924151
20. Lam CCO, McDonald SJ. Comparison of pushing techniques used in the second stage of labour for their effect on maternal perception of fatigue in the early postpartum period among Chinese women. Hong Kong Journal of Gynaecology, Obstetrics and Midwifery 2010;10(1):13-21. 2924153
21. Lam COC. Comparison of Two Pushing Techniques Used in the Second Stage of Labour for Their Effect on Maternal Perception of Fatigue in the Early Postpartum Period: a Randomised Controlled Trial [thesis]. Victoria: La Trobe University, 2006. 2924154
22. Brincat C, Lewicky-Gaupp C, Patel D, Sampselle C, Miller J, Delancey JO, et al. Fecal incontinence in pregnancy and post partum. International Journal of Gynaecology & Obstetrics 2009;106(3):236-8. 2924156
23. Low LK, Miller JM, Guo Y, Ashton-Miller JA, DeLancey JOL, Sampselle CM. Spontaneous pushing to prevent postpartum incontinence: a randomized, controlled trial. International Urogynecology Journal 2013;24(3):453-60. 2924157
24. Low LK, Miller JM, Sampselle C. Prevention of post partum urinary incontinence using perineal massage, spontaneous pushing and muscle training. Female Pelvic Medicine & Reconstructive Surgery 2010;16(5 Suppl 2):S70. 2924158
25. Low LK, Sampselle C, Miller JM. Spontaneous pushing during 2nd stage labor to reduce risk of incontinence. Female Pelvic Medicine and Reconstructive Surgery 2013; Vol. 19. 5312625
26. Maresh M, Choong KH, Beard RW. Delayed pushing with lumbar epidural analgesia in labour. British Journal of Obstetrics and Gynaecology 1983;90:623-7. 2924160
27. Mayberry LJ, Hammer R, Kelly C, True-Driver B, De A. Use of delayed pushing with epidural anesthesia: findings from a randomized, controlled trial. Journal of Perinatology 1999;19(1):26-30. 2924162
28. Plunkett B, Lin A, Wong C, Grobman W, Peaceman A. A randomized trial of the management of the second stage of labor in nulliparous patients with continuous epidural analgesia [abstract]. American Journal of Obstetrics and Gynecology 2001;184(1):S119. 2924164
29. Plunkett BA, Lin A, Wong CA, Grobman WA, Peaceman AM. Management of the second stage of labor in nulliparas with continuous epidural analgesia. Obstetrics & Gynecology 2003;102(1):109-14. 2924165
30. Ravindran RS, Viegas OJ, Tasch MD, Cline PH, Deaton RL, Brown TR. Bearing down at the time of delivery and the incidence of spinal headache in parturients. Anesthesia and Analgesia 1981;60(7):524-6. 2924167
31. Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. American Journal of Obstetrics and Gynecology 2006;194(1):10-3. 2924169
32. Schaffer JI, Bloom SL, Casey BM, McIntire DD, Nihira MA, Leveno KJ. A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. American Journal of Obstetrics and Gynecology 2005;192:1692-6. 2924170
33. Wai CY, McIntire DD, Atnip SD, Schaffer JI, Bloom SL, Leveno KJ. Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. International Urogynecology Journal 2011;22:1293-8. 2924171
34. Simpson KR, James DC. Effects of immediate versus delayed pushing during second-stage labor on fetal well-being. Nursing Research 2005;54(3):149-57. 2924173
35. Thomson AM. Comparison of 'Pushing' Techniques in the Second Stage of Labour: Pilot Study [MSc thesis]. Manchester, UK: University of Manchester, 1990. 2924176
36. Thomson AM. A pilot study of a randomised controlled trial of pushing techniques in the second stage of labour. Proceedings of 22nd International Congress of Confederation of Midwives; 1991 Oct 7-12; Kobe, Japan. 1991:76. 2924175
37. Thomson AM. Maternal behaviour during spontaneous and directed pushing in the second stage of labour. Journal of Advanced Nursing 1995;22:1027-34. 2924177
38. Thomson AM. Pushing techniques in the second stage of labour. Journal of Advanced Nursing 1993;18:171-7. 2924178
39. Vause S, Congdon HM, Thornton JG. A randomized controlled trial of immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia. British Journal of Obstetrics and Gynaecology 1998;105 Suppl 17:85. 2924180
40. Vause S, Congdon HM, Thornton JG. Immediate and delayed pushing in the second stage of labour for nulliparous women with epidural analgesia: a randomised controlled trial. British Journal of Obstetrics and Gynaecology 1998;105:186-8. 2924181
41. Vaziri F, Arzhe N, Asadi N, Pourahmad S, Moshfeghy Z. Spontaneous pushing in lateral position versus valsalva maneuver during second stage of labor on maternal and fetal outcomes: randomized clinical trial. Iranian Red Crescent Medical Journal 2016 in-press. 5312627
42. Yildirim G, Beji NK. Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth 2008;35:25-30. 2924183
43. Aviram A, Ashwal E, Hiersch L, Hadar E, Wiznitzer A, Yogev Y. The effect of intrapartum dental support use among nulliparous during the second stage of labor - a randomized controlled study. Journal of Maternal-Fetal & Neonatal Medicine 2016;29(6):868-71. 5312629
44. Barnett MM, Humenick SS. Infant outcome in relation to second stage labor pushing method. Birth 1982;9:221-8. 2924185
45. Boulvain M, Irion O, Mentha V. Multicentre randomised controlled trial of delayed pushing for women with continuous epidural analgesia. 21st Conference of the Swiss Society of Gynecology and Obstetrics; 1998; Switzerland. 1998:5. 2924187
46. Caldeyro-Barcia R. The effects of humanized labour on fetal outcome. Personal communication 1990. 2924189
47. Chang S-C, Chou M-M, Lin K-C, Lin L-C, Lin Y-l, Kuo S-C. Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery 2011;27:825-31. 2924191
48. Gleeson NC, Griffith AP. The management of the second stage of labour in primiparae with epidural analgesia. British Journal of Clinical Practice 1991;45(2):90-1. 2924193
49. Haseeb Y, Alkunaizi A, Al Turki H, Aljama F, Sobhy S. The impact of valsalva's versus spontaneous pushing techniques during second stage of labor on postpartum maternal fatigue and neonatal outcome. Saudi Journal of Medicine and Medical Sciences 2014;2(2):101-5. 5312631
50. Lai ML, Lin K, Li HY, Shey K, Gau M. Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women. Journal of Nursing Research 2009;17(1):62-72. 2924195
51. Liston RM. Effect of delayed expulsive efforts on rate of spontaneous delivery with continuous epidural analgesia. Personal communication 1996. 2924198
52. Liston RM, Writer WDR, Young DC, McNeil K. Delayed maternal pushing does not reduce mid-forceps rate. Proceedings of 19th Annual Meeting of Society for Obstetric Anesthesia and Perinatology; 1987 May 20-23; Halifax, Nova Scotia, Canada. 1987:94. 2924197
53. Martinez-Lopez V, De La Fuente P, Iniguez A, Freese UE, Mendez-Bauer C. Comparison of two methods of bearing down during second stage of labour. Proceedings of 31st Meeting of Society for Gynecologic Investigation; 1984; San Francisco, California, USA. 1984:Abstract no: 76P. 2924200
54. Matsuo K, Mudd JV, Kopelman JN, Atlas RO. Duration of second stage of labor while wearing a dental support device: a pilot study. Journal of Obstetrics and Gynaecology Research 2009;35(4):672-8. 2924202
55. Mc Queen J, Myrlea L. Lumbar epidural analgesia in labour. British Medical Journal 1977;1:640-1. 2924204
56. Moraloglu O, Kansu-Celik H, Tasci Y, Karakaya BK, Yilmaz Y, Cakir E, et al. The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women. Journal of Maternal-Fetal & Neonatal Medicine 2016 [Epub ahead of print]. 5312633
57. Mulvey SF. McRoberts manoeuvre or pushing study (McMOPS). ClinicalTrials.gov (accessed 7 November 2008). 2924206
58. Parnell C, Langhoff-Roos J, Iversen R, Damgaard P. Pushing in the expulsive phase of labour. Ugeskrift for Laeger 1993;155:2259-62. 2924208
59. Parnell C, Langhoff-Roos J, Iversen R, Damgaard P. Pushing method in the expulsive phase of labor: a randomized trial. Acta Obstetricia et Gynecologica Scandinavica 1993;72:31-5. 2924209
60. Parnell C, Langhoff-Roos J, Iversen R, Damgaard P. Pushing method in the expulsive phase of labour. Acta Paediatrica 1992;Suppl 384:17. 2924210
61. Phipps H, Charlton S, Dietz HP. Can antenatal education influence how women push in labour? [abstract]. Journal of Paediatrics and Child Health 2007;43(Suppl 1):A67-8. 2924212
62. Phipps H, Charlton S, Dietz HP. Can antenatal education influence how women push in labour? a pilot randomised controlled trial on maternal antenatal teaching for pushing in second stage of labour (PUSH STUDY). Australian and New Zealand Journal of Obstetrics and Gynaecology 2009;49:274-8. 2924213
63. Pickrell MD, Buxton EJ, Redman CWE, Obhrai M. Epidural analgesia: delayed pushing and augmentation in the second stage do not reduce operative deliveries. Proceedings of Silver Jubilee British Congress of Obstetrics and Gynaecology; 1989 July 4-7; London, UK. 1989:128. 2924215
64. Snyder S. Trial to compare two management techniques in the second stage of labor: pushing vs non-pushing. Personal communication 1996. 2924217
65. Spiby H. A randomised controlled trial to evaluate the use of spontaneous bearing down efforts in the second stage of labour. Personal communication 1990. 2924219
66. Walker C, Rodríguez T, Herranz A, Espinosa JA, Sánchez E, Espuña-Pons M. Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. International Uroginecology Journal 2012;23(9):1249-56. 2924221
67. Yeates DA, Roberts JE. A comparison of two bearing-down techniques during the second stage of labor. Journal of Nurse-Midwifery 1984;29(1):3-11. 2924223
68. NCT02137200 . Optimizing management of the 2nd stage of labor: Multicenter randomized trial (OMSS). clinicaltrials.gov/ct2/show/NCT02137200 Date first received: 9 May 2014. 5312635
69. Hauspurg A. Passive descent in obese nulliparous gravidae. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 24 March 2014] 2014. 2924225
70. Aderhold K, Roberts JE. Phases of second stage labor. Four descriptive case studies. Journal of Nurse-Midwifery 1991;36:267-75.
71. Albers LL, Borders N. Minimizing genital tract trauma and related pain following spontaneous vaginal birth. Journal of Midwifery & Women's Health 2007;52:246-53.
72. Aldrich CJ, Spencer JAD, Wyatt JS, Delpy DT. The effect of maternal pushing on fetal cerebral oxygenation and blood volume during the second stage of labour. British Journal of Obstetrics and Gynaecology 1995;102:448-53.
73. Bates RG, Helms CW, Duncan A, Edmonds DK. Uterine activity in the second stage of labour and the effect of epidural analgesia. British Journal of Obstetrics and Gynaecology 1985;92:1246-50.
74. Beynon C. The normal second stage of labour. A plea for reform in its conduct. Journal of Obstetrics and Gynaecology of the British Commonwealth 1957;64:815-20.
75. Bloom SL, Casey BM, Schaffer JI, McIntire SS, Leveno KJ. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. American Journal of Obstetrics and Gynecology 2006;194(1):10-3.
76. Brancato RM, Church S, Stone PW. A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor. JOGN: Journal of Obstetric, Gynecologic & Neonatal Nursing 2008;37(1):4-12.
77. Brincat C, Lewicky-Gaupp C, Patel D, Sampselle C, Miller J, Delancey JO, et al. Fecal incontinence in pregnancy and post partum. International Journal of Gynaecology & Obstetrics 2009;106(3):236-8.
78. Buhimschi CS, Buhimschi IA, Malinow AM. Pushing in labor: performance and not endurance. American Journal of Obstetrics and Gynecology 2002;186:1336-44.
79. Caldeyro-Barcia R, Giussi G, Storch E, Poseiro JJ, Lafaurie N, Kettenhuber K, et al. The bearing-down efforts and their effects on fetal heart rate, oxygenation and acid base balance. Journal of Perinatal Medicine 1981;9:63-7.
80. Cunningham FG, Macdonald G. Williams Obstetrics. New York: McGraw-Hill, 2001.
81. Fraser WD, Marcoux S, Krauss I, Douglas J, Goulet C, Boulvain M. Multicenter, randomized, controlled trial of delayed pushing for nulliparous women in the second stage of labour with continuous epidural analgesia. American Journal of Obstetrics and Gynecology 2000;182(5):1165-72.
82. Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2012, Issue 5. [DOI: 10.1002/14651858.CD002006.pub3]
83. Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstetrics & Gynecology 2002;99:29-34.
84. Hanson L. Second-stage labor care. Challenges in spontaneous bearing down. Journal of Perinatal & Neonatal Nursing 2009;23:31-9.
85. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
86. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of sample. BMC Medical Research Methodology 2005;5:1-10.
87. Lai M, Lin K, Li HY, Shey KS, Gau M. Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women. Journal of Nursing Research 2009;17:62-71.
88. Le Ray C, Audibert F, Goffinet F, Fraser W. When to stop pushing? Consequences of pushing duration on maternal and neonatal outcomes in nullipara with epidural. American Journal of Obstetrics and Gynecology 2008;199(6 Suppl 1):S37. 2924135
89. Menez-Orieux C, Linet T, Philippe H-J, Boog G. Delayed versus immediate pushing in the second stage of labor for nulliparous parturients with epidural analgesia: a meta-analysis of randomized trials [Poussée retardée versus poussée immédiate lors de la seconde phase du travail chez les nullipares sus anesthesie péridurale]. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 2005;34(5):440-7.
90. Minato JF. Is it time to push? Examining rest in second-stage labor. AWHONN Lifelines 2001;4:20-3.
91. Petrou S, Coyle D, Fraser WD, for the PEOPLE (Pushing Early or Pushing Late with Epidural) study group. Cost-effectiveness of a delayed pushing policy for patients with epidural anesthesia. American Journal of Obstetrics and Gynecology 2000;182(5):1158-64.
92. Prins M, Boxem J, Lucas C, Hutton E. Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG: an international journal of obstetrics and gynaecology 2011;118(6):662-70.
93. The Nordic Cochrane Centre: The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre: The Cochrane Collaboration, 2014.
94. Roberts CL, Torvaldsen S, Cameron CA, Olive E. Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis. BJOG: an international journal of obstetrics and gynaecology 2004;111:1333-40.
95. Roberts J, Goldstein SA, Gruener JS. A descriptive analysis of involuntary bearing-down efforts during the expulsive phase of labor. Journal of Obstetric, Gynecologic, and Neonatal Nursing 1987;16:48-55.
96. Roberts J, Woolley D. A second look at the second stage of labor. Journal of Obstetric, Gynecologic, and Neonatal Nursing 1996;25:415-23.
97. Roberts JE. The "push" for evidence: management of the second stage. Journal of Midwifery and Womens Health 2002;47:2-15.
98. Roberts J, Hanson L. Best practices in second stage labour care: maternal bearing down and positioning. Journal of Midwifery & Women's Health 2007;52(3):238-45. [DOI: 10.1016/j.jmwh.2006.12.011]
99. Schaffer JI, Bloom SL, Casey BM, McIntire DD, Nihira MA, Leveno KJ. A randomized trial of the effects of coached vs uncoached maternal pushing during the second stage of labor on postpartum pelvic floor structure and function. American Journal of Obstetrics and Gynecology 2005;192:1692-6.
100. Thompson AM. Pushing techniques in the second stage of labour. Journal of Advanced Nursing 1995;22:1027-34.
101. Thorp JA, Breedlove G. Epidural analgesia in labour: an evaluation on risks and benefits. Birth 1996;23:63-83.
102. Tuuli MG, Frey HA, Odibo AO, Macones GA, Cahill AG. Immediate compared with delayed pushing in the second stage of labor. Obstetrics & Gynecology 2012;120(3):660-8.
103. Wai CY, McIntire DD, Atnip SD, Schaffer JI, Bloom SL, Leveno KJ. Urodynamic indices and pelvic organ prolapse quantification 3 months after vaginal delivery in primiparous women. International Urogynecology Journal 2011;22:1293-8. 2924171
104. Lemos A, Amorim MMR, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour.. Cochrane Database of Systematic Reviews 2011, Issue 5. [DOI: 10.1002/14651858.CD009124]
105. Lemos A, Amorim MMR, Dornelas de Andrade A, de Souza AI, Cabral Filho JE, Correia JB. Pushing/bearing down methods for the second stage of labour. Cochrane Database of Systematic Reviews 2015, Issue 10. [DOI: 10.1002/14651858.CD009124.pub2]