Reducing Perineal Tears: The Effect of Pushing Methods and Length of 2nd Stage of Labor

Objective: To evaluate the current literature evidence for the effects of either instructed or spontaneous pushing on perineal laceration incidence during delivery and the duration of second stage of labor. Background: Lacerations (tears) of the perineum are common among women during delivery, increasing pain, infection risk, and other problems for women. Furthermore, prolonged second stage of labor has been shown a risk factor for lacerations. Pushing methods could have an effect on the incidence of lacerations and duration of second stage of labor. Methods: Thorough search of online databases for the highest levels of evidence relating to the topic within the last 5 years. Results: Spontaneous pushing versus instructed pushing method may decrease laceration incidence, according to limited evidence; however, other studies do not find this effect to be statistically significant. In addition, spontaneous pushing results in longer second stage of labor, having a possible indirect effect on laceration incidence. Conclusion: Since no evidence strongly supports either pushing method as beneficial for decreasing lacerations, further research on this topic seems warranted. For now, either method may be accepted for use in current medical practice