Spontaneous Versus Directed Pushing Technique: Maternal and Neonatal Outcomes: A Comparative Study in Northern Upper Egypt

Abstract

Background: Maternal pushing during the 2^nd stage of labor is indispensable and important contributor to the involuntary expulsive force developed by uterine contraction results to influence on the mother and fetus. Aim: the study was conducted to compare spontaneous versus Valsalva (directed) pushing techniques at the second stage of labor on maternal and fetal outcomes. Methods: Setting: Delivery Unit of El-Fayoum General and University Hospitals. Design: A quasi-experimental comparative study. Subjects: A purposive sample of a total of 100 primiparous women; 50 in the Valsalva (directed) pushing group & 50 in the spontaneous pushing group. Tools: four tools were used; structured interviewing questionnaire sheet, Apgar score, Visual analog scale, and women satisfaction questionnaire. Results: The duration of the second stage of labor was shorter (5-10 min) in a spontaneous pushing (54.0%) group compared to the direct pushing group (2.0%). Oxygen wasn't used at all in spontaneous pushing group compared to 74.0% of directed pushing group. Postpartum hemorrhage was too little in spontaneous pushing group (96.0%) compared to 36.0% of the directed pushing group. Also, all women in the spontaneous pushing group experienced mild perineal pain compared to 32.0% in the directed pushing group (p<0.001). The individual items of the VAS were significantly higher in the directed pushing group than those in the spontaneous pushing group. According to Apgar's score, there was a significant difference between the two groups during both the first and fifth minutes of birth. In the directed pushing group, a higher proportion of babies are admitted to ICU than those in the spontaneous pushing group (18.0 percent versus 10.0 percent). Conclusion; spontaneous pushing during the 2^nd stage of labor enhanced neonatal and maternal outcomes; whilst directed pushing was associated with an increased duration of the 2^nd stage of labor and risk of adverse neonatal outcomes. Recommendations: It may be recommended that spontaneous pushing during the second stage of childbirth be included in the procedure for maternal hospitals.