Continuous lumbar epidural analgesia in labour—does delaying ‘pushing’ in the second stage reduce the incidence of instrumental delivery?

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Abstract
It has been proposed that delaying ‘pushing’ in the second stage in labours associated with epidural analgesia will reduce the incidence of instrumental delivery. Two similar groups of 100 primigravid women in labour conducted under epidural analgesia were compared. The first group commenced ‘pushing’ as soon as the second stage was diagnosed, whilst the second group was asked to wait at least one hour before commencing to ‘push’. Sixty-three in the second group were able to comply. The incidence of forceps delivery was not reduced in the group that had been asked to wait, in fact it was higher. Delaying ‘pushing’ in the second stage in labour associated with epidural analgesia is difficult to apply uniformly and is of no practical benefit.