Implementing an enhanced recovery after surgery program for cesarean delivery is associated with reduced length of stay, cost of care, and opioid analgesia use.

influenced the conclusions. Given the constituents of the metaanalysis, it is certainly difficult for obstetricians to have a clear view. Looking at the study data, all trends of obstetrical outcomes indeed favor delayed pushing although differences are no longer significant. Given the increased risk of chorioamnionitis (and the absence of effect on the rate of spontaneous delivery), it seems likely that obstetricians would modify their practice and use more frequently early pushing at the start of the second stage. I suspect however that given the "grey zone" results seen here, obstetricians will not frankly adopt this attitude and will continue using delayed pushing, at least for specific cases and particularly in patients with the fetus positioned at a high station.What does this mean for anesthesiologists and is there any consequence for our practice? The simple answer is no as in all cases, the anesthesiologist working in obstetrics has the duty to provide effective analgesia, all along the duration of labor, whatever the underlying obstetrical management. It is however common to observe that patients who are receiving neuraxial analgesia do not feel any urge to push. This means that pushing must then be directed by the obstetrician or the midwife.

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