Abstract

In recent year, there has been an increased trend to the physiological approach to labor. Physiological (spontaneous) pushing in upright position is one of the practices that promote the normal physiological process. Effect of physiological pushing versus directed pushing on the duration of the second stage of labor, mode of birth and Apgar. A randomized controlled trial was completed on 191 women who gave birth at a maternity unit in Iran between August and December 2009. Randomization occurred upon confirmation of full dilatation of the cervix with using block randomization. In the intervention group (n = 100), with full dilatation of the cervix and a fetal head plus 1, the midwives providing care suggested they commenced pushing in upright position only when they felt the urge to do so and gave no specific instructions about the timing and duration of pushing. In the control group (n = 91), women were coached by the midwife to use closed-glottis pushing three to four times in supine position during each contraction immediately as the same period. Mean duration of the second stage of labor in the primiparous women was 47.38±36.75 and 57.12±33.10 min in the intervention and control groups, respectively; the difference was significant (p < 0.0001). In the multiparous, women in the second stage of labor lasted for 26.12±23.43 and 33.20±22.76 min in the intervention and control groups, respectively, which was significantly different (p < 0.0001). One woman in the control group and 2 mother in the intervention group undertook cesarean surgery (p = 1). Apgar scores were similar in both groups. Physiological pushing was not associated with demonstrable adverse outcome. It seems that this technique can reduce the duration of the second stage of labor and it can be a safe method during the second stage of labor without any harm for mother and baby.

Key words: Spontaneous pushing, directed pushing, valsalva, second stage of labor