Prolonged second stage (time restraints = guidance)
- Primiparous = 3 hours (total active and passive) with regional anaesthesia, 2 hours without regional anaesthesia.
- Multiparous = 2 hours (total active and passive) with regional anaesthesia, 1 hour without regional anaesthesia.
If the labouring woman is exhausted she will not be able to push effectively.
Certain medical conditions are exacerbated with the valsalva manoeuvre:
- NYHA class III or IV cardiac disease
- hypertensive crisis
- cerebrovascular disease
- proliferative retinopathy
- myasthenia gravis
- spinal cord injury (at risk of autonomic dysreflexia).