A study finds that giving more time to push in first labors cuts the cesarean rate for prolonged second stage in half. The American College of Obstetricians & Gynecologists’ sets the threshold for prolonged second stage at first births when laboring with an epidural at 3 hours. Seventy-eight study participants with epidurals who had exceeded this threshold were assigned either to standard management, which was “expedited delivery” via cesarean or instrumental vaginal delivery, or to a minimum of one additional hour to labor. The cesarean rate when given at least one more hour was 20% (8/41) versus 43% (16/37) in the standard management group. No differences were found in maternal or neonatal outcomes, although the study was too small to detect small, but clinically important, differences. Of course, the reduction in cesareans was a very large, clinically important difference.

The Take-Away: Declining vaginal instrumental or cesarean delivery when the sole indication is having exceeded a preset time limit increases probability of vaginal birth without increasing adverse outcomes.