Comparison of Pushing Techniques Used in the Second Stage of Labour for Their Effect on Maternal Perception of Fatigue in the Early Postpartum Period among Chinese Women Abstract

Christine CO LAM, Susan J MCDONALD

In Hong Kong, most women giving birth in public hospitals are taught to use the directed (Valsalva) method to push. Shortcomings of directed pushing have been demonstrated, and there has been an increased appreciation of and interest in the physiological approach to labour. The objective of this study was to determine the relationship between early postpartum fatigue and the pushing technique used during the second stage of labour and to collect available information on fatigue levels in the immediate postpartum period among Chinese women.

A randomised controlled trial was undertaken in 2005 to determine any differences between use of the directed and spontaneous pushing techniques in the second stage of labour with respect to maternal fatigue in the first 24 hours’ postpartum. Using the visual analogue scale–fatigue, women were asked to indicate their perceived level of fatigue at the onset of labour, at the beginning of the second stage, within 15 minutes of the baby’s birth, and around 24 hours’ postpartum.

Seventy-three nulliparous women were randomly allocated to either the control group (directed pushing method, n=38) or the experimental group (spontaneous pushing method, n=35). Women in the experimental group had longer second stages of labour but perceived less fatigue within 15 minutes of childbirth and at 24 hours after delivery. The difference between the two groups was not statistically significant. The control group had higher rates of instrumental delivery, a finding that was statistically significant (p=0.048). There was no statistically significant difference between the groups for any other maternal or neonatal outcome measured.

The spontaneous pushing technique is safe, less exhausting, and achieves a statistically significant decrease in instrumental delivery. This provides information health care professionals should use to evaluate ways of assisting women with childbirth.

Hong Kong J Gynaecol Obstet Midwifery 2010; 10:13-21

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