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FPIN's Clinical Inquiries
From the Family Practice Inquiries Network

Use of Delayed Pushing in Nulliparous Birthing Patients With an Epidural

Lee Dresang, MD
Leslie Christensen, MA-LIS

American Family Physician. 2025;112(2):198-199.

Author disclosure: No relevant financial relationships.

LEE DRESANG, MD, Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison

LESLIE CHRISTENSEN, MA-LIS, Ebling Library for the Health Sciences, University of Wisconsin School of Medicine and Public Health

Address correspondence to Lee Dresang, MD, at Lee.Dresang@fammed.wisc.edu.

Author disclosure: No relevant financial relationships.

  1. 1.Di Mascio D, Saccone G, Bellussi F, et al. Delayed versus immediate pushing in the second stage of labor in women with neuraxial analgesia: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2020;223(2):189-203.
  2. 2.Cahill AG, Srinivas SK, Tita ATN, et al. Effect of immediate vs delayed pushing on rates of spontaneous vaginal delivery among nulliparous women receiving neuraxial analgesia: a randomized clinical trial. JAMA. 2018;320(14):1444-1454.
  3. 3.Szu LT, Chou PY, Lin PH, et al. Comparison of maternal and fetal outcomes between delayed and immediate pushing in the second stage of vaginal delivery: systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet. 2021;303(2):481-499.
  4. 4.Lemos A, Amorim MM, Dornelas de Andrade A, et al. Pushing/bearing down methods for the second stage of labour. Cochrane Database Syst Rev. 2017(3):CD009124.
  5. 5.Tuuli MG, Frey HA, Odibo AO, et al. Immediate compared with delayed pushing in the second stage of labor: a systematic review and meta-analysis. Obstet Gynecol. 2012;120(3):660-668.
  6. 6.American College of Obstetricians and Gynecologists. First and second stage labor management: ACOG Clinical Practice Guideline No. 8. Obstet Gynecol. 2024;143(1):144-162.
  7. 7.National Institute for Health and Care Excellence. Intrapartum care. NICE guideline NG235. September 29, 2023. Updated January 8, 2025. Accessed June 23, 2025. https://www.nice.org.uk/guidance/ng235

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email questions@fpin.org.

Copyright © Family Physicians Inquiries Network. Used with permission.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN’s Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.

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