Effects of Pushing Techniques in Birth on Mother and Fetus: A Randomized Study

Abstract

Two basic pushing techniques are utilized in the second stage of labor: spontaneous pushing while breathing with an open glottis, and a Valsalva-like method of pushing against a closed glottis during breath holding. Participants in this study were 100 primiparous women at 38–42 weeks’ gestation who were considered to be at low risk and who anticipated spontaneous vaginal delivery. Fifty of the women were randomly chosen to push spontaneously while 50 employed the Valsalva-like technique during the second stage of labor—the period from full cervical dilatation until delivery was completed. The 2 groups did not differ significantly in demographic characteristics, the frequency of a nonreassuring fetal surveillance pattern, or the use of oxytocin. The second stage of labor, as well as the duration of the expulsion phase, was significantly longer in those women doing Valsalva-type pushing. Group differences in the frequency of episiotomy and perineal tears were not significant. Infants whose mothers had pushed spontaneously had higher 1- and 5-minute Apgar scores as well as higher umbilical cord blood pH and PO2 levels. On logistic regression analysis there were no significant associations between the pushing technique employed and the duration of the second stage of labor, fundal pressure, or Apgar scores. Women who had pushed spontaneously were more satisfied than those doing Valsalva-like pushing. They reported having fewer problems, and felt that they had pushed more effectively. The findings in this randomized trial suggest that the second stage of labor can be shortened without interventions, and with improved outcomes for the newborn infant, by teaching parturients to push spontaneously.