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Epidurals Can Prolong Pushing Stage of Labor

From The Thinking Parent newsletter

Although labor may be more comfortable with epidural anesthesia, it may also act to make the pushing stage (known as the second stage) of labor longer.

What the researchers did
Researchers in Germany analyzed 1,200 consecutive vaginal deliveries in one hospital. The second stage of labor was defined as starting once the cervix was fully effaced and 10 centimeters dilated and ending when the baby was delivered. A prolonged second stage of labor was defined as a time period lasting more than two hours.

Labor was induced in almost 20 percent of women, and epidurals were given in the first stage of labor to about 30 percent of women. Augmentation of labor was started in the first stage of labor in about 42 percent of women and in the second stage of labor in 7 percent of women.

What the researchers found
The average age of women in the study was 31 years. A little more half (53.3 percent) were first-time deliveries. The average length of the second stage of labor was 70 minutes. The duration of the second stage was prolonged (longer than two hours) in 27 percent of the deliveries.

Women who had never delivered before had significantly longer pushing stages than women who had delivered before (103 minutes versus 33 minutes, on average). The rates of prolonged second stage of labor were much higher among first-time mothers (35 percent) than in women who had delivered before (5 percent). The duration of pushing was much shorter, however, when oxytocin (such as Pitocin) was given during the first stage of labor.

Epdural anesthesia was strongly related to the length of pushing. Women who did not receive epidural anesthesia had an average second stage of labor of 44 minutes, whereas women who did receive epidural anesthesia had an average of 124 minutes. Furthermore, 48 percent of the women with epidural anesthesia had a prolonged pushing stage of labor, whereas only 9 percent of the women without epidurals did.

The second stage of labor was also likely to be longer if the baby presented in the occipito-posterior position (which causes “back labor”). Those with this presentation had second stage labors lasting 131 minutes on average, compared to 69 minutes in those without this presentation.

Birth weight and maternal age were not associated with a prolonged second stage of labor. This finding is interesting because previous studies found that increased birth weight and maternal age are associated with longer second stages of labor.

What this means for you
If you are having a first baby, you can expect that the second stage of labor could be long and perhaps prolonged (greater than two hours). Fortunately, the length of pushing should be significantly shorter in subsequent deliveries.

The use of epidural anesthesia will also likely lengthen the second stage of labor. Therefore, if you choose to have an epidural, be aware that you may be pushing for longer than you would if you choose not to. It is not clear what effect a prolonged second stage of labor has on mother or baby.

The researchers question the automatic use of oxytocin augmentation when epidural anesthesia is given. They found that oxytocin administered during the second stage of labor seemed to prolong labor rather than shorten it (as it does when administered in the first stage of labor). However, the researchers did not cite the reasons why oxytocin was administered during the second stage.

Source: Schiessl, B., et al., January 2005, Obstetrical parameters influencing the duration of the second stage of labor. European Journal of Obstetrics & Gynecology and Reproductive Biology, 118, 17-20.

© Jennifer Hahn

NFO contributor, Dr. Jennifer Hahn, is the editor of The Thinking Parent, a quarterly publication reviewing research of interest to parents: child development and parenting, pregnancy and childbirth, physical health, mental health and education. With more than 12 years of experience in research at the Johns Hopkins School of Medicine, Dr. Hahn received her Ph.D. from the University of Maryland Baltimore County and completed her residency at the University of Virginia Health Sciences Center. She is the mother of two daughters.

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