Early pushing urge in the laboring patient

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I recently cared for a patient who was at 38 weeks gestation, was 8 cm dilated, and had a strong urge to push. Should I have encouraged her to push or delayed pushing until she was completely dilated?—G.K., MO.
Roxanne Ferguson, EdD, MSN, RN, replies: The urge to push despite being fully dilated is a phenomenon known as early pushing urge (EPU). It's been thought to be caused by the fetal head pressing on the mother's pelvic floor. Although some women don't experience this urge, the women that do seem to have an involuntary, uncontrollable urge to push. The incidence of EPU reportedly ranges from 7.6% to 54%.1 Although EPU seems to be common, how to manage it is controversial.
A literature review by Tsao identified two recommendations for management of EPU.2
The National Institute for Health and Care Excellence in the United Kingdom recommends that women in labor should be in charge of their own pushing urges.3 The American Congress of Obstetricians and Gynecologists published a position statement in 2017 on the management of low-risk women in labor, noting that obstetric care providers should be familiar with and consider using low-interventional approaches for the intrapartum management of labor to decrease operative interventions. Examples of these approaches include interventions such as side-lying pushing and alternating pushing.4
Labor nurses caring for a patient experiencing EPU need to provide supportive care and notify the healthcare team to determine a plan of care. Each patient's labor process is unique and should be individualized. Labor nurses should feel comfortable when instructed to let patients push when they experience EPU, but only when they've consulted with the healthcare provider and specific maternal conditions have been met, such as the cervix being 8 to 9 cm dilated with continued progression of dilation, including a soft, pliable cervix.
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