Valsalva Manoeuver vs. Spontaneous Pushing in Second Stage Labour

INTRODUCTION AND HYPOTHESISThe risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management.METHODSThis was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Selfreport of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage.RESULTSNo statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value = 0.57) or in combination with prenatal perineal massage (P value = 0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected.CONCLUSIONSSpontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups. Database: Medline 9. Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Author(s): Chang, Su-Chuan; Chou, Min-Min; Lin, Kuan-Chia; Lin, Lie-Chu; Lin, Yu-Lan; Kuo, Su-Chen Source: Midwifery; Dec 2011; vol. 27 (no. 6); p. 825-831 Publication Date: Dec 2011 Publication Type(s): Comparative Study Journal Article Available in print at Patricia Bowen Library and Knowledge Service West Middlesex university Hospital from Midwifery Abstract:OBJECTIVESTo evaluate maternal labour pain, fatigue, duration of the second stage of labour, the women's bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position.DESIGNQuasi-experimental study.SETTINGMedical centre in Taichung, Taiwan.PARTICIPANTS66 Women giving birth at the hospital, with 33 primigravidas assigned to each group.INTERVENTIONSDuring the second stage of labour, the women in the experimental group pushed from an upright position and were given support to push spontaneously; the women in the control group pushed from a supine position and were supported via Valsalva pushing.OUTCOME MEASURES Pain scores were recorded at two evaluation time points: at 10 cm of cervical dilation and one hour after the first pain score evaluation. One to four hours after childbirth, the trained nurses collected the fatigue and pushing experience scores.FINDINGSThe women in the experimental group had a lower pain index (5.67 versus 7.15, p = 0.01), lower feelings of fatigue post birth (53.91 versus 69.39, p < 0.001), a shorter duration of the second stage of labour (91.0 versus 145.97, p = 0.02) and more positive labour experiences (39.88 versus 29.64, p < 0.001) compared with the control group. There was no significant difference in the Apgar score for newborn infants during either the first minute (7.70 versus 7.73, p = 0.72) or the fifth minute (8.91 versus 8.94, p = 0.64).KEY CONCLUSIONSThe pushing intervention during the second stage of labour lessened pain and fatigue, shortened the pushing time and enhanced the pushing experience.IMPLICATIONS FOR PRACTICEPushing interventions can yield increased satisfaction levels for women giving birth.