[Comparing the effects of spontaneous pushing versus Valsalva pushing technique on outcome of delivery in primiparous women]

The valsalva pushing technique is used routinely in the second stage of labor in many countries, and it is accepted as standard obstetric method in Iran. The purpose of this study was to determine the effects of spontaneous pushing, versus, valsalva pushing technique in birth on outcome of delivery in primiparas. This clinical trial study was conducted on 100 primiparas. Samples were randomized to either a spontaneous pushing group [open glottis pushing while breathing out] or a valsalva type pushing group [closed glottis pushing while holding their breath]. The length of stages of delivery, perineal tears, postpartum hemorrhage and satisfaction were evaluated in mothers and apgar scores at 1 and 5 minutes were evaluated in newborns. Data were analyzed using statistical Mann-Whitney, Chi-square and independent t-test. The duration of expulsion phase of the second stage of labor was significantly longer in valsalva-type pushing [P=0.004]. The result indicated that the incidence of episiotomy in spontaneous pushing group [P=0.003] and postpartum hemorrhage in valsalva pushing group [P=0.002] was more. The baby fared better with spontaneous pushing, with higher 1- minute apgar score. After the birth, women expressed greater satisfaction with spontaneous pushing. Educating women for the spontaneous pushing technique in the first stage of labor and providing support for spontaneous pushing in the second stage result in a shorter second stage without interventions and in improved newborn outcomes