Clinical Question:
During the second stage of labor, is coaching to push more beneficial than not coaching to push?

Bottom Line:
Pushing time is reduced by an average of 15 minutes when women are coached to push during the expulsive phase of labor. Other than that, coached pushing demonstrated neither benefit nor harm. The choice is a matter of preference. This study included only women who were not receiving epidural analgesia or oxytocin.

Reference:
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. Am J Obstet Gynecol 2006;194:10-13.

Study Design:
Randomized controlled trial (nonblinded)

Synopsis:
The objective of this study was to compare obstetrical outcomes associated with coached versus uncoached pushing during the second stage of labor. Upon reaching the second stage, previously consented nulliparous women with uncomplicated labors and without epidural analgesia were randomly assigned to coached (n = 163) versus uncoached (n = 157) pushing. Women allocated to coaching received standardized closed glottis pushing instructions by certified nurse-midwives with proper ventilation encouraged between contractions. These midwives also attended those women assigned to no coaching to ensure that any expulsive efforts were involuntary. The second stage of labor was abbreviated by approximately 13 minutes in coached women (P = .01). There were no other clinically significant immediate maternal or neonatal outcomes between the 2 groups.