From the Research
The recommended duration for passive pushing in a mother with a fully dilated cervix is typically up to 2 hours for nulliparous women and up to 1 hour for multiparous women, as supported by the most recent and highest quality study 1.
Key Considerations
- Passive pushing involves allowing the fetus to descend passively through the birth canal with the mother's natural contractions before beginning active pushing efforts.
- This approach can help reduce maternal exhaustion and decrease the risk of pelvic floor trauma.
- During this time, the mother should be encouraged to rest between contractions and change positions as comfortable to facilitate fetal descent.
- The healthcare provider should monitor both maternal and fetal well-being throughout this period, including regular assessment of fetal heart rate and maternal vital signs.
Benefits of Passive Pushing
- Decreases the total length of pushing by 25.4 minutes (95% CI 13.9-37.0) 1.
- Decreases the incidence of instrument-assisted vaginal delivery in western countries (RR 0.85,95% CI 0.74-0.97) 1.
- Decreases maternal postpartum fatigue score by 0.67 points (95% CI -1.09 to -0.26) 1.
- Increases the Apgar score at 1 minute by 0.19 points (95% CI 0.10-0.27) 1.
Monitoring and Interventions
- Regular assessment of fetal heart rate and maternal vital signs is crucial during passive pushing.
- If there are concerns about maternal or fetal status, or if there is no progress despite adequate time, the healthcare team may recommend transitioning to active pushing or consider other interventions.
- The decision to transition to active pushing or intervene should be based on individual patient factors and clinical judgment.