[Pushing technique in the expulsive phase of labor. A randomized study]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Perinatal Research

Background:

• The expulsive phase of labor involves pushing, which can be spontaneous or directed (forced).
• Previous research suggested spontaneous pushing offers benefits like fewer fetal heart rate (FHR) changes and reduced birth canal trauma.

Purpose of the Study:

• To compare spontaneous pushing with forced pushing in nulliparous women.
• To evaluate the impact of different pushing techniques on labor duration, fetal well-being, and maternal outcomes.

Main Methods:

• A randomized trial involving 350 primiparous women comparing spontaneous vs. forced pushing.
• Assessment of second-stage labor duration, umbilical artery pH, CTG (cardiotocography) changes, and birth canal injuries.
• Analysis of pushing techniques (open vs. closed glottis) based on actual usage during labor.

Main Results:

• No significant differences were observed between spontaneous and forced pushing groups regarding key maternal and fetal variables.
• A majority (65.6%) of women in the spontaneous pushing group utilized the closed glottis technique for over half of the expulsive phase.
• Women predominantly using the open glottis technique experienced shorter second-stage labor but delivered lower birth weight infants.

Conclusions:

• In this trial, recommending spontaneous bearing down did not yield superior maternal or infant outcomes compared to the closed glottis technique.
• The choice of pushing technique (spontaneous vs. forced, open vs. closed glottis) may influence labor dynamics and infant birth weight, warranting further investigation.