ABSTRACT
This is a quasi-randomised clinical trial, with 62 low-risk pregnant women in the second stage of labour. They were randomly allocated in control (CG) (n = 31) and intervention (IG) (n = 31) groups. The IG performed spontaneous pushing with pursed lips breathing while the CG was oriented to perform directed pushing associated with Valsalva Manoeuvre (VM). There was no difference between the groups regarding the occurrence of episiotomy (RR 1,1; 95%IC 1,0 to 1,2). However, there was a decrease in the duration of the maternal pushing by 3.2 min (MD 3,2; 95%CI 1,4 to 5,1) and a difference in maternal anxiety (Md (IQR) IG 46 (35-52), CG 51 (44-56) p:0,049), both favouring the IG. Spontaneous pushing was effective in reducing the duration of the pushing and showed a difference in maternal anxiety but did not decrease the maternal and neonatal outcomes. Brazilian Clinical Trials Registry (ReBEC) under the identifier: RBR-556d22IMPACT STATEMENTWhat is already known on the subject? Spontaneous pushing reduces the duration of pushing time when compared to directed pushing with VM but has no effect on other maternal and neonatal outcomes, based on a low quality of evidence.What do the results of this study add? No subject has been published on the subject. Our results suggest that the use spontaneous pushing with pursed lips breathing reduces the duration of the pushing by 3.2 min, also showing a difference in maternal anxiety. This result may indicate its use for emotional control when compared to the directed pushing.What are the implications of these findings for clinical practice and/or further research? These findings may signal an attitude in decision-making about guiding the breathing pattern in the expulsive stage.
Subject(s)
Delivery, Obstetric , Labor Stage, Second , Delivery, Obstetric/methods , Episiotomy , Female , Humans , Infant, Newborn , Lip , Pregnancy , Valsalva ManeuverABSTRACT
The choice of respiratory advice during childbirth has been controversial. This study aimed to identify the prescription of respiratory guidelines during labor and to evaluate the association between the presence of these orientations and maternal satisfaction. A cross-sectional study with 192 postpartum women with vaginal delivery was performed. A questionnaire and a visual analog scale were used to acquire the socioeconomic information, to identify respiratory orientations received during labor and maternal satisfaction. Measures of central tendency, frequencies, the odds ratio for associations with a 95% confidence interval were calculated. Deep breathing was the most indicated form (81.25%) and the most performed in an autonomous way (15.10%). Orientations of fast and superficial respiratory frequency (13.54%) and Valsalva Maneuver (93.22%) were still present. Postpartum women who received respiratory orientations in either the first (OR: 6.28, 95% CI 2.32-16.94) or the second labor periods (OR: 4.84, CI95% 1.33 - 17.67) had more satisfaction with their delivery. Respiratory orientations contribute to increase maternal satisfaction at the time of delivery.
As escolhas de orientações respiratórias durante o parto sempre foram controversas. O estudo teve como objetivo identificar a prescrição de orientações respiratórias durante o trabalho de parto (TP) e avaliar a associação entre a presença dessas orientações com a satisfação materna. Estudo de corte transversal com 192 puérperas com parto vaginal. Aplicou-se um questionário para aquisição das informações socioeconômicas e das orientações respiratórias recebidas durante o TP e uma escala visual analógica para identificar a satisfação materna. Medidas de tendência central e frequências foram calculadas, bem como odds ratio para as associações com intervalo de confiança 95%. A respiração profunda foi a mais orientada (81,25%) e a mais realizada de forma autônoma (15,10%). As orientações respiratórias do tipo "respiração cachorrinho" (13,54%) e a manobra de Valsalva (93,22%) ainda estiveram presentes. As puérperas que receberam as orientações respiratórias tanto no primeiro (OR: 6,28; IC95% 2,32- 16,94) como no segundo (OR: 4,84; IC95% 1,33 - 17,67) período do parto tiveram maior satisfação com seu parto. O fornecimento de orientações respiratórias no momento do parto contribui para aumentar a satisfação materna.
