Objective-To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations.Methods-This was a secondary analysis of NICHD Assessment of Perinatal Excellence (APEX) cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008-2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10 cm cervical dilation were included. Women in whom pushing was delayed by ≥60 minutes (delayed group) were compared with those who initiated pushing within 30 minutes (early group). Multivariable regression analyses were used to assess the independent association of delayed pushing with mode of delivery, length of second stage and other maternal and perinatal outcomes (significance defined as p<0.05).Results-Of 21,034 women in the primary analysis sample, pushing was delayed in 18.4% (n=3870). Women who were older, privately insured, or non-Hispanic white, as well as those who Conclusion-In this large birth cohort, delayed pushing was associated with longer second stage duration, increased odds of cesarean delivery, and increased odds of postpartum hemorrhage, but was not associated with neonatal morbidity. HHS Public Access

No abstract