Open-glottis Pushing Technique Versus the Valsalva Pushing Technique in the Second Stage of Labor
Condition: Evidence-Based Practice; Labor; Prolonged, Second Stage; Labor; Fetal Acidosis Complicating Labor and Delivery
MeSH terms: Acidosis
Study type: Interventional

Summary: 
      Pushing has been discussed for decades, primarily in terms of facilitating care in the second
      stage of labor and maternal/fetal outcomes.

      Valsalva-type pushing is the pushing performed by a pregnant woman by holding her breath.
      Various physiological findings argue against the Valsalva maneuver may adversely affect the
      acid-base balance and cerebral oxygenation of the fetus. It has been shown that a long apnea
      period (long closed glottis) associated with the Valsalva maneuver during the expulsive stage
      of labor increases lactate concentration in the mother and the fetus and adversely affects
      the fetal acid-base balance.

      Spontaneous pushing is the pushing movements that occur naturally in the second stage of
      birth. Spontaneous pushing is part of the natural birth process and encourages women to trust
      the natural functioning of their bodies. When pushing with an open glottis, fetal placental
      circulation is preserved since the pressure on the chest does not increase and there are
      fewer hemodynamic effects.

      The World Health Organization (WHO) recommends that women in the second stage of labor should
      be encouraged and supported to follow their pushing urges. The WHO states that healthcare
      professionals involved in obstetric care should avoid the Valsalva maneuver due to the lack
      of evidence that this technique has any benefit in the second stage of labor. The WHO
      supports spontaneous pushing in its recommendations for a positive birth experience. Safe
      termination of labor for both the mother and fetus is one of the primary duties of all
      healthcare professionals. There are few studies examining the maternal and fetal effects of
      the pushing types used during labor, especially their effects on the acid-base balance in the
      fetus. To contribute to the quality of evidence on the subject, the effects of Valsalva-type
      and spontaneous pushing techniques in the second stage of labor on fetal acid-base level and
      maternal outcomes were examined.

      Hypotheses of the Research H1: Spontaneous pushing reduces the mother's pain level. H2:
      Spontaneous pushing increases the mother's birth satisfaction. H3: Spontaneous pushing
      positively affects the acid-base balance of the fetus. H4: Valsalva-type pushing increases
      the mother's pain level. H5: Valsalva-type pushing reduces the mother's birth satisfaction.
      H6: Valsalva-type pushing negatively affects the acid-base balance of the fetus.
    


Intervention name(s): Spontaneous pushing technique
Intervention type(s): Other
Intervention description(s): Pregnant women selected for the experimental group were trained on spontaneous pushing technique in the first stage of labor. During the second stage of labor, the women were encouraged and supported in this direction.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Spontaneous pushing-Experimental Group Valsalva-type pushing-Control Group
Masking: Single (Participant)
Primary purpose: Other