Evidence suggests that for primiparous females delivered with epidural anesthesia maternal comfort is accomplished at the expense of a longer second stage, higher frequencies of operative delivery as well as reduced muscular tone of pelvic floor needed for normal internal rotation of the fetal head, and the reflex maternal urge to bear down. This study was conducted to determine the effect of antenatal exercises on bearing down in primiparous under epidural anesthesia. A prospective, randomized, single-blind, controlled trial was performed. Overall, 70 primiparous expected vaginal delivery under epidural anesthesia with a single healthy fetus at their 14-15 weeks’ of gestation were included, aged 18-35 years with a body mass index not exceeding 25 kg/m2. The participants were randomly assigned into 2 groups: group (A), receiving antenatal exercise program and advice relevant to each trimester of pregnancy, while group (B) continued their ordinary life style after receiving the advice as group (A). The unpaired t-test revealed significant differences between both groups (A &B) in duration of second stage of labor (p < 0.05) with a significant decrease in duration of latent and active phases of 2nd stage of labor in group (A) participants. Also, neonates of group (A) showed statistically higher values of Apgar score at the 1st and 5th minute of life (p < 0.05) compared to neonates of group (B). It can be concluded that antenatal exercises are very effective in decreasing labor complications for mothers and fetuses as well as facilitating bearing down during 2nd stage of labor in primiparous under epidural anesthesia.


  • Albers L, Sedler KD, Bedrick EJ, Teaf D, Peralta P (2006) Factors related to genital tract trauma in normal spontaneous vaginal births. Birth, 33(2):94e100.
  • Alexander JM, Lucas MJ, Ramin S, McIntire DD, Leveno KJ (1998) The course of labor with and without epidural analgesia. Am J Obstet Gynecol, 178:516-20.
  • Allen VM, Baskett TF, O’Connell CM, McKeen D, Allen AC (2009) Maternal and perinatal outcomes with increasing duration of the second stage of labor. Obstet Gynecol, 113:1248–58.
  • American College of Obstetricians and Gynecologists (2015) Committee Opinion No. 650 Summary: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol., 126(6):1326–1327.
  • American College of Obstetricians and Gynecologists (2002) Exercise during pregnancy and the postpartum period: number 267, January 2002 Committee on Obstetric Practice. Int J Gynecol Obstet., 77(1):79–81. https://doi.org/10.1016/S0020-7292(02)80004-2
  • Anim-Somuah M, Smyth RMD, Jones L (2011) Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev; (12):CD000331. https://doi.org/10.1002/14651858.CD000331.pub3
  • Cheng YW, Shaffer BL, Nicholson JM, Caughey AB (2014) Second stage of labor and epidural use: a larger effect than previously suggested. Obstet Gynecol., 123(3):527–535.
  • Clapp III JF (1990) The course of labor after endurance exercise during pregnancy. American journal of obstetrics and gynecology, 163(6):1799-805.
  • Davies GA, Wolfe LA, Mottola MF, MacKinnon C (2003) Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol., 28(3):330–341. https://doi.org/10.1139/h03-024
  • Flynn P, Franiek J, Janssen P, Hannah WJ, Klein MC (1997) How can second-stage management prevent perineal Trauma? Critical review. Can Fam Phys, 43:73e84.
  • Gupta JK, Sood A, Hofmeyr GJ, Vogel JP (2017) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews, (5): CD002006. https://doi.org/10.1002/14651858.CD002006.pub4.www.cochranelibrary.com
  • Gupta JK (2012) “Position in the second stage of labour for women without epidural anaesthesia”. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD002006.pub3
  • Hanson L (2009) Second-stage labor care: challenges in spontaneous bearing down. J Perinat Neonatal Nurs., 23:31–39.
  • Khan I (2018) The Impact of Land Use on Spatial Variations of Begging in District Lahore_Pakistan. International Journal of Geography and Geology, 7(2): 27-34.
  • Khor LJ, Jeskins G, Cooper GM, Paterson-Brown S (2000) National obstetric anaesthetic practice in the UK 1997/1998. Anaesthesia, 359:1168-72. https://doi.org/10.1046/j.1365-2044.2000.01720.x
  • Kibuka M, Thornton JG (2017) Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev, 359:CD008070. https://doi.org/10.1002/14651858.CD008070.pub3
  • Lavender T, Mlay R (n.d.) Position in the second stage of labour for women without epidural anaesthesia: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization.
  • Lawani M, Alihonou E, Akplogan B, Poumarat G (2008) Exercise in pregnancy for elderly primigravida. Br J Obstet Gynecol, 51:476–480.
  • Lawrence A, Lewis L, Hofmeyr G J, Styles C. (2013). Maternal positions and mobility during first stage labour. Reviews, 2013 (8).
  • Le Ray C, Audibert, Goffinet, Fraser (209) When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. Am J Obstet Gynecol,, 201(4):361.
  • Liu EH, Sia AT (2004) Rates of caesarean section and instrumental vaginal delivery in nulliparous women after low concentration epidural infusions or opioid analgesia: systematic review. BMJ, 359:1410. https://doi.org/10.1136/bmj.38097.590810.7C
  • Metwally M, Ong K, Ledger W, Li TC (2008) Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis of the evidence Fertil Steril, 90:714–726.
  • National Collaborating Centre for Women’s and Children’s Health (UK). Intrapartum care for healthy women and babies. London: RCOG Press; 2014 Dec. (NICE Clinical Guidelines, No 190) http://www.ncbi.nih.gov/books/NBK49388/
  • Nor CSM, Mohamed RKH, Mohamed B, Hassan NAC (2020) Human Resources Management Practices and its Impact on Employee Commitment Mong Staffs of Road Transport Department, Perak, Malaysia. Journal of Environmental Treatment Techniques, 8(1): 28-34.
  • Oppenheimer L, Black A (2013) The second-stage of labor. In: Posner GD, Dy J, Black AY, Jones GD, eds. Oxorn-Foot Human Labor & Birth. 6th ed. Blacklick, Ohio: McGraw Hill: 266–281.
  • Piantadosi S (2017) Clinical trials: a methodologic perspective. Hoboken: Wiley.
  • Redshaw M, Henderson J (2014) Safely delivered: a national survey of women’s experience of maternity care. https://www.npeu.ox.ac.uk/reports/807-safely-delivered
  • Roberts CL, Algert CS, Cameron CA, Torvaldsen S (2005) A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia. Acta Obstet Gynecol Scand, 359:794-8. https://doi.org/10.1111/j.0001-6349.2005.00786.x
  • Roberts CL, Torvaldsen S, Cameron CA, Olive E (2004) Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis. Br J Obstet Gynaecol, 111(12):1333e40.
  • Roberts J (2003) A new understanding of the second-stage of labor: implications for nursing care. J Obstet Gynecol Neonatal Nurs., 32:794–801.
  • Rouse DJ, Weiner SJ, Bloom SL, Varner MW, Spong CY, Ramin SM, et al. (2009) Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes. Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am ObstetGynecol,, 201:357.e1–7.
  • Salvesen KÅ, Stafne SN, Eggebø TM, Mørkved S (2014) Does regular exercise in pregnancy influence duration of labor? A secondary analysis of a randomized controlled trial. Acta obstetricia et gynecologica Scandinavica, 93(1):73-9.
  • Schaeffer J, Bloom S, Casey B, McIntire D, Nihira M, Leveno K (2005) A randomized trial of the effects of coached vs uncoached maternal pushing during the second-stage of labor on postpartum pelvic floor structure and function. AmJObstet Gynecol., 192:1692–1696.
  • Tinloy J, Chuang CH, Zhu J, Pauli J, Kraschnewski JL, Kjerulff KH. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Women’s Health Issues. 2014 Jan 1;24(1):e99-104.
  • Wittels B (1991) Does epidural anesthesia affect the course of labor and delivery? Semin Perinatol, 15:358-67.
  • Yildirim G, Beji NK (2008) Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth, 35:25–30.


This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.