Spontaneous Pushing in Lateral Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A Randomized Clinical Trial

Farideh Vaziri, Amene Arzhe, Nasrin Asadi, Saeedeh Pourahmad, Zeinab Moshfeghy, Farideh Vaziri, Amene Arzhe, Nasrin Asadi, Saeedeh Pourahmad, Zeinab Moshfeghy

Abstract

Background: There are concerns about the harmful effects of the Valsalva maneuver during the second stage of labor.

Objectives: Comparing the effects of spontaneous pushing in the lateral position with the Valsalva maneuver during the second stage of labor on maternal and fetal outcomes.

Methods: Inclusion criteria in this randomized clinical trial conducted in Iran were as follows: nulliparous mothers, live fetus with vertex presentation, gestational age of 37 - 40 weeks, spontaneous labor, and no complications. The intervention group pushed spontaneously while they were in the lateral position, whereas the control group pushed using Valsalva method while in the supine position at the onset of the second stage of labor. Maternal outcomes such as pain and fatigue severity and fetal outcomes such as pH and pO2 of the umbilical cord blood were measured.

Results: Data pertaining to 69 patients, divided into the intervention group (35 subjects) and control group (34 subjects), were analyzed statistically. The mean pain (7.80 ± 1.21 versus 9.05 ± 1.11) and fatigue scores (46.59 ± 21 versus 123.36 ± 43.20) of the two groups showed a statistically significant difference (P < 0.001). Moreover, the mean duration of the second stage in the intervention group was significantly higher than that in the control group (76.32 ± 8.26 minutes versus 64.56 ± 15.24 minutes, P = 0.001). The umbilical cord blood pO2 levels of both groups showed a statistically significant difference (28.29 ± 11.76 versus 18.83 ± 9.86, P < 0.001), whereas their pH levels were not significantly different (P = 0.10).

Conclusions: Spontaneous pushing in the lateral position reduced fatigue and pain severity of the mothers. Also, it did not worsen fetal outcomes. Thus, it can be used as an alternative method for the Valsalva maneuver.

Keywords: Fatigue; Fetal Outcomes; Labor Pain; Natural Childbirth; Nulliparity; Second Labor Stage; Valsalva Maneuver.

Figures

Figure 1.. Flow Chart of Study
Figure 1.. Flow Chart of Study

References

    1. Roberts JE. The "push" for evidence: management of the second stage. J Midwifery Womens Health. 2002;47(1):2–15.
    1. Cunningham FG, leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. 23. New York: McGraw Hill; 2010. Williams Obstetrics.
    1. Sampselle CM, Miller JM, Luecha Y, Fischer K, Rosten L. Provider support of spontaneous pushing during the second stage of labor. J Obstet Gynecol Neonatal Nurs. 2005;34(6):695–702. doi: 10.1177/0884217505281904.
    1. Prins M, Boxem J, Lucas C, Hutton E. Effect of spontaneous pushing versus Valsalva pushing in the second stage of labour on mother and fetus: a systematic review of randomised trials. BJOG. 2011;118(6):662–70. doi: 10.1111/j.1471-0528.2011.02910.x.
    1. Hanson L. Second-stage labor care: challenges in spontaneous bearing down. J Perinat Neonatal Nurs. 2009;23(1):31–9. doi: 10.1097/JPN.0b013e318196526b. quiz 40-1.
    1. Nordstrom L, Achanna S, Naka K, Arulkumaran S. Fetal and maternal lactate increase during active second stage of labour. BJOG. 2001;108(3):263–8.
    1. Lemos A, Dean E, de Andrade AD. The Valsalva maneuver duration during labor expulsive stage: repercussions on the maternal and neonatal birth condition. Rev Bras Fisioter. 2011;15(1):66–72.
    1. Fraser D, Cooper M. Myles textbook for midwives. 15 ed. Philadelphia: Churchill livingstone Elsevier;; 2009.
    1. Simpson KR, James DC. Effects of immediate versus delayed pushing during second-stage labor on fetal well-being: a randomized clinical trial. Nurs Res. 2005;54(3):149–57.
    1. Roberts J, Hanson L. Best practices in second stage labor care: maternal bearing down and positioning. J Midwifery Womens Health. 2007;52(3):238–45. doi: 10.1016/j.jmwh.2006.12.011.
    1. Brancato RM, Church S, Stone PW. A meta-analysis of passive descent versus immediate pushing in nulliparous women with epidural analgesia in the second stage of labor. J Obstet Gynecol Neonatal Nurs. 2008;37(1):4–12. doi: 10.1111/j.1552-6909.2007.00205.x.
    1. Roberts CL, Torvaldsen S, Cameron CA, Olive E. Delayed versus early pushing in women with epidural analgesia: a systematic review and meta-analysis. BJOG. 2004;111(12):1333–40.
    1. Bloom SL, Casey BM, Schaffer JI, McIntire DD, Leveno KJ. A randomized trial of coached versus uncoached maternal pushing during the second stage of labor. Am J Obstet Gynecol. 2006;194(1):10–3. doi: 10.1016/j.ajog.2005.06.022.
    1. Yildirim G, Beji NK. Effects of pushing techniques in birth on mother and fetus: a randomized study. Birth. 2008;35(1):25–30. doi: 10.1111/j.1523-536X.2007.00208.x.
    1. Priddis H, Dahlen H, Schmied V. What are the facilitators, inhibitors, and implications of birth positioning? A review of the literature. Women Birth. 2012;25(3):100–6. doi: 10.1016/j.wombi.2011.05.001.
    1. Nieuwenhuijze MJ, de Jonge A, Korstjens I, Bude L, Lagro-Janssen TL. Influence on birthing positions affects women's sense of control in second stage of labour. Midwifery. 2013;29(11):e107–14. doi: 10.1016/j.midw.2012.12.007.
    1. de Jonge A, Rijnders ME, van Diem MT, Scheepers PL, Lagro-Janssen AL. Are there inequalities in choice of birthing position? Sociodemographic and labour factors associated with the supine position during the second stage of labour. Midwifery. 2009;25(4):439–48. doi: 10.1016/j.midw.2007.07.013.
    1. Downe S, Gerrett D, Renfrew MJ. A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia. Midwifery. 2004;20(2):157–68. doi: 10.1016/S0266-6138(03)00052-4.
    1. Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli GB. Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. Biomed Res Int. 2014;2014:638093. doi: 10.1155/2014/638093.
    1. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S240–52. doi: 10.1002/acr.20543.
    1. Fadaizadeh L, Emami H, Samii K. Comparison of visual analogue scale and faces rating scale in measuring acute postoperative pain. Arch Iran Med. 2009;12(1):73–5.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–7.
    1. Hewlett S, Dures E, Almeida C. Measures of fatigue: Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for severity, effect, and coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF-36 VT), and Visual Analog Scales (VAS). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S263–86. doi: 10.1002/acr.20579.
    1. Pugh LC, Milligan RA, Gray S, Strickland OL. First stage labor management: An examination of patterned breathing and fatigue. Birth. 1998;25(4):241–5.
    1. Dervaitis KL, Poole M, Schmidt G, Penava D, Natale R, Gagnon R. ST segment analysis of the fetal electrocardiogram plus electronic fetal heart rate monitoring in labor and its relationship to umbilical cord arterial blood gases. Am J Obstet Gynecol. 2004;191(3):879–84. doi: 10.1016/j.ajog.2004.05.059.
    1. Kelly M, Johnson E, Lee V, Massey L, Purser D, Ring K, et al. Delayed versus immediate pushing in second stage of labor. MCN Am J Matern Child Nurs. 2010;35(2):81–8. doi: 10.1097/NMC.0b013e3181cae7ad.
    1. Chang SC, Chou MM, Lin KC, Lin LC, Lin YL, Kuo SC. Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery. 2011;27(6):825–31. doi: 10.1016/j.midw.2010.08.009.
    1. Roberts JE. A new understanding of the second stage of labor: implications for nursing care. J Obstet Gynecol Neonatal Nurs. 2003;32(6):794–801.
    1. Chalk A. Limits on second stage pushing and time. Br J Midwifery. 2004;12(9)
    1. Lai ML, Lin KC, Li HY, Shey KS, Gau ML. Effects of delayed pushing during the second stage of labor on postpartum fatigue and birth outcomes in nulliparous women. J Nurs Res. 2009;17(1):62–72. doi: 10.1097/JNR.0b013e3181999e78.
    1. Karlstrom A, Nystedt A, Johansson M, Hildingsson I. Behind the myth--few women prefer caesarean section in the absence of medical or obstetrical factors. Midwifery. 2011;27(5):620–7. doi: 10.1016/j.midw.2010.05.005.
    1. Graham JE, Lobel M, DeLuca RS. Anger after childbirth: An overlooked reaction to postpartum stressors. Psychol Women Q. 2002;26(3):222–33.
    1. Troy NW. Is the significance of postpartum fatigue being overlooked in the lives of women? MCN Am J Matern Child Nurs. 2003;28(4):252–7. quiz 258-9.
    1. Hansen SL, Clark SL, Foster JC. Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial. Obstet Gynecol. 2002;99(1):29–34.
    1. Ebrahimzadeh S, Golmakani N, Kabirian M, Shakeri MT. Study of correlation between maternal fatigue and uterine contraction pattern in the active phase of labour. J Clin Nurs. 2012;21(11-12):1563–9. doi: 10.1111/j.1365-2702.2012.04084.x.
    1. Taylor J, Johnson M. The role of anxiety and other factors in predicting postnatal fatigue: from birth to 6 months. Midwifery. 2013;29(5):526–34. doi: 10.1016/j.midw.2012.04.011.
    1. Haseeb YA, AlTurki H, Aljama F, Al kunaizi AN, Sobhy S. The impact of valsalva′s versus spontaneous pushing techniques during second stage of labor on postpartum maternal fatigue and neonatal outcome. Saudi J Med Sci. 2014;2(2):101. doi: 10.4103/1658-631x.137000.

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