well... when are the nurses gonna read these studies?

This simply backs up the research done since the mid '70's. However it
seems that in the last 30 years, L&D personnel missed reading about
it. I have started keeping a small file of Chrochraine quality
abstracts in my doula bag.....just in case.
JB
Effects of Pushing Techniques in Birth on Mother and Fetus: A
Randomized Study
a.. Gulay Yildirim, PhD11Gulay Yildirim is a Research Assistant and
Nezihe Kizilkaya Beji is a Professor in the Florence Nightingale
School of Nursing, Department of Obstetric and Gynecologic Nursing,
Istanbul University, Istanbul, Turkey.Gulay Yildirim, PhD, Florence
Nightingale School of Nursing, Department of Obstetric and Gynecologic
Nursing, Istanbul University, Sisli 34381, Istanbul,
Turkey.<javascript: popRef('a1% 20c1')>, and
b.. Nezihe Kizilkaya Beji, MD11Gulay Yildirim is a Research Assistant
and Nezihe Kizilkaya Beji is a Professor in the Florence Nightingale
School of Nursing, Department of Obstetric and Gynecologic Nursing,
Istanbul University, Istanbul, Turkey.<javascript: popRef('a1' )>
a.. 1Gulay Yildirim is a Research Assistant and Nezihe Kizilkaya Beji
is a Professor in the Florence Nightingale School of Nursing,
Department of Obstetric and Gynecologic Nursing, Istanbul University,
Istanbul, Turkey.
This work was supported by the Research Fund of Istanbul University,
Istanbul, Turkey (Project No.: T-383/08032004) .

Gulay Yildirim, PhD, Florence Nightingale School of Nursing,
Department of Obstetric and Gynecologic Nursing, Istanbul University,
Sisli 34381, Istanbul, Turkey.
Abstract
Background: The Valsalva pushing technique is used routinely in the
second stage of labor in many countries, and it is accepted as
standard obstetric management in Turkey. The purpose of this study was
to determine the effects of pushing techniques on mother and fetus in
birth in this setting.

Methods: This randomized study was conducted between July 2003 and
June 2004 in Bakirkoy Maternity and Children's Teaching Hospital in
Istanbul, Turkey. One hundred low-risk primiparas between 38 and 42
weeks' gestation, who expected a spontaneous vaginal delivery, were
randomized to either a spontaneous pushing group or a Valsalva-type
pushing group. Spontaneous pushing women were informed during the
first stage of labor about spontaneous pushing technique (open glottis
pushing while breathing out) and were supported in pushing
spontaneously in the second stage of labor. Similarly, Valsalva
pushing women were informed during the first stage of labor about the
Valsalva pushing technique (closed glottis pushing while holding their
breath) and were supported in using Valsalva pushing in the second
stage of labor. Perineal tears, postpartum hemorrhage, and hemoglobin
levels were evaluated in mothers; and umbilical artery pH, Po2 (mmHg),
and Pco2 (mmHg) levels and Apgar scores at 1 and 5 minutes were
evaluated in newborns in both groups.

Results: No significant differences were found between the two groups
in their demographics, incidence of nonreassuring fetal surveillance
patterns, or use of oxytocin. The second stage of labor and duration
of the expulsion phase were significantly longer with Valsalva-type
pushing. Differences in the incidence of episiotomy, perineal tears,
or postpartum hemorrhage were not significant between the groups. The
baby fared better with spontaneous pushing, with higher 1- and
5-minute Apgar scores, and higher umbilical cord pH and Po2 levels.
After the birth, women expressed greater satisfaction with spontaneous
pushing.

Conclusions: Educating women about the spontaneous pushing technique
in the first stage of labor and providing support for spontaneous
pushing in the second stage result in a shorter second stage without
interventions and in improved newborn outcomes. Women also stated that
they pushed more effectively with the spontaneous pushing technique.
(BIRTH 35:1 March 2008)