USON, Emmarie T.

BSN III-D3

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,and Zeinab Moshfeghy

I. SUMMARY
Introduction: There can be different harmful effects with the use of Valsalva maneuver during
the second stage of labor. The study aims to compare the effects of spontaneous pushing in the
lateral position versus with the Valsalva maneuver during the second stage of labor on maternal
and fetal outcomes.

Method: The study is a randomized clinical trial, the researchers gathered their participants in the
two teaching hospitals in Iran. The inclusion criteria of the study: Nulliparous mothers; with live
fetus in a vertex presentation; AOG of 37-40 weeks; spontaneous labor and absent chronic
diseases. They were selected based on the inclusion criteria, studying records and interviewing
the mothers. The data collection was performed by an observer who was a member of the
research team. All of the participants received routine care in the unit until the beginning of the
second stage of labor.

Results: 69 participants completed the study. The participants were divided into two one group
being the intervention group and the other group being the control group. There was a significant
difference with the means of pain severity in the second stage of labor, fatigue scores, pushing
duration and second stage length between the two groups. However, there were no significant
differences between the two groups regarding the number of contractions. The mean duration of
the second stage in the intervention group (8.26 minutes) has shown a statistically significant
difference compared to the control group (15.24 minutes). This study showed that spontaneous
pushing in the lateral position, compared with the Valsalva maneuver, reduced pain severity in
the second stage of labor and fatigue level, but did not shorten the duration of the second stage of
labor. Fetal outcomes such as fetal heart rate patterns, Apgar scores, and umbilical cord blood pH
levels did not differ between the two groups, but the level of umbilical cord blood pO2 of the
spontaneous pushing group was higher than that of the Valsalva maneuver group.

Discussion: Spontaneous pushing group were allowed to be in the lateral position for as long as
they wished, that is why there is a probability that the stability of the mothers position may
 contribute to the decrease in the fatigue severity in the intervention group compared with the
control group. The relationship between pain and fatigue suggested that fatigue severity reduction
could be effective for reducing pain perception. The duration of the second stage for the
spontaneous pushing group was higher; it did not cause an increase in maternal fatigue severity.
The longer second stage of labor in the spontaneous pushing group did not worsen fetal
outcomes. Thus spontaneous pushing in the lateral position reduced fatigue and pain severity of
the mothers, and did not worsen fetal outcomes; this spontaneous pushing in the lateral position is
an alternative method for the valsalva maneuver when in the second stage of labor.

II. REFLECTION and SIGNIFICANCE OF THE STUDY

Assisting in the labor room, we can see how difficult, tiring and painful being in labor is.
Through this study, the mothers who are in labor can be given an option on how they can have a
less painful and tiring labor, which can also help with the prevention of harm for both the
newborn and the mother.
For the nursing education, maternal counseling on giving birth in order for the mother to
have an idea on what to expect and do in when giving birth.
In the nursing practice, nurses must be open on the different ways on how to manage the
second stage of labor, prioritizing the safety and comfort of both the mother and the baby.

References
Vaziri, F., Arzhe, A., Asadi, N., Pourahmad, S., & Moshfeghy, Z. (2016). Spontaneous Pushing in Lateral
Position versus Valsalva Maneuver During Second Stage of Labor on Maternal and Fetal Outcomes: A
Randomized Clinical Trial. Iranian Red Crescent Medical Journal,18(10). doi:10.5812/ircmj.29279

Haseeb, Y., Alkunaizi, A., Al Turki, H., Aljama, F., & Sobhy, M. (2017). The Impact of Valsalvas
versus Spontaneous Pushing Techniques during Second Stage of Labor on Postpartum Maternal Fatigue
and Neonatal Outcome