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Weakness of exertion
Last reviewed: 04.07.2025
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Weakness of pushing may be primary or secondary.
Primary weakness of pushing is observed in case of weakness of the abdominal muscles in women who have given birth many times with excessively stretched and relaxed abdominal muscles, in case of infantilism, obesity, as well as in case of defects of the abdominal wall in the form of hernias of the linea alba, umbilical and inguinal hernias, in case of myasthenia, in case of spinal injuries. Overflow of the urinary bladder, intestines and stomach have an inhibitory effect on the development of pushing. Negative emotions, fear of childbirth during the period of expulsion in primiparous women are often accompanied by weakness of pushing. The latter can be observed due to a disorder of innervation on the basis of organic lesions of the central nervous system (poliomyelitis, consequences of brain and spinal injuries, etc.).
Weakness of pushing is often observed in primary and secondary weakness of labor due to insufficient reflex reactions due to the lack of proper pressure from the presenting part on the nerve endings in the pelvis.
Secondary weakness of pushingobserved in case of muscle fatigue and general fatigue of the woman in labor when overcoming obstacles from the birth canal, after suffering debilitating extragenital diseases. It is often found in women in labor who develop, in order to speed up labor, the so-called "premature pushing".
Weakness of pushing may occur reflexively with severe pain caused by compression of intestinal loops between the anterior abdominal wall and the uterus, observed during epidural anesthesia.
Symptoms of weak pushing are expressed in the prolongation of the expulsion period. Pushing becomes short-term, weak and rare. The advancement of the presenting part of the fetus is delayed or suspended. The prolongation of the expulsion period leads to edema of the external genitalia, signs of compression of adjacent organs and the development of endometritis during labor appear. The fetus is at risk of asphyxia and death. Hysterography shows a low amplitude of contractions of the striated muscles.
The diagnosis is established on the basis of clinical data and hysterography.
The management of labor in cases of weak pushing should essentially be the same as in cases of secondary weakness of labor. In cases of weak pushing, obstetric anesthesia is usually avoided and uterine stimulating agents are used (oxytocin intravenously or in tablet form).
In case of abdominal incompetence, Verbov's bandage or its modification from a sheet is used. Perineo- or episiotomy is used according to indications.
If the above measures are unsuccessful and there are indications for rapid delivery (acute fetal hypoxia, endometritis, prolonged expulsion period), obstetric forceps or a vacuum extractor are used. Squeezing the fetus according to Kristeller is traumatic and dangerous for the mother and fetus and should not be used.