@article {Brancato:January/February 2008:0884-2175:4,
	author = "Brancato, Robyn M.",
	author = "Church, Sara",
	author = "Stone, Patricia W.",
	title = "A Meta-Analysis of Passive Descent Versus Immediate Pushing in Nulliparous Women With Epidural Analgesia in the Second Stage of Labor",
	journal = "Journal of Obstetric, Gynecologic, & Neonatal Nursing",
	volume = "37",
	year = "January/February 2008",
	abstract = "Objective:&#8194; <P></P>To determine which method of pushing&#8212;passive descent or early pushing&#8212;most benefits women with epidurals during second-stage labor. Data sources:&#8194; <P></P>MEDLINE, CINAHL, and Cochrane Database. Study selection:&#8194; <P></P>Studies limited to randomized controlled trials in English, comparing passive descent to early pushing in women with effective epidural analgesia. Data extraction:&#8194; <P></P>A hand search was performed. Data included number of instrument-assisted deliveries (forceps and vacuum); noninstrumental or spontaneous vaginal births, cesarean births, pushing time, episiotomies, lacerations; maternal fatigue; and fetal well-being. Data synthesis:&#8194; <P></P>Seven studies were eligible for a sample size of 2,827 women. Pooled data indicate that passive descent increases a woman's chance of having a spontaneous vaginal birth (relative risk: 1.08; 95% confidence interval: 1.01-1.15; <I>p </I>&#61; 0.025), decreases risk of having an instrument-assisted deliveries (relative risk: 0.77; 95% confidence interval: 0.77-0.85; <I>p </I>&#8804; 0.0001), and decreases pushing time (mean difference: &#8722;0.19 hours; 95% confidence interval: &#8722;0.27 to &#8722;0.12; <I>p </I>&#8804; 0.0001). No differences were found in rates of cesarean births (relative risk: 0.80; 95% confidence interval: 0.57-1.12; <I>p </I>&#61; 0.19), lacerations (relative risk: 0.88; 95% confidence interval: 0.72-1.07; <I>p </I>&#61; 0.20), or episiotomies (relative risk: 0.97; 95% confidence interval: 0.88-1.06; <I>p </I>&#61; 0.45). Conclusions:&#8194; <P></P>Significant positive effects were found indicating that passive descent should be used during birth to safely and effectively increase spontaneous vaginal births, decrease instrument-assisted deliveries, and shorten pushing time.",
	pages = "4-12(9)",
	url = "http://www.ingentaconnect.com/content/bpl/jogn/2008/00000037/00000001/art00004"
	doi = "doi:10.1111/j.1552-6909.2007.00205.x"
}