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

Pushing in the expulsive phase of labour can be forced or follow the spontaneous urge to bear down. Recent studies have shown that spontaneous pushing results in a longer second stage, fewer CTG changes, higher pH in the umbilical artery and less damage to the birth canal. In a randomized trial of spontaneous vs. forced pushing in 350 primipareous women, we found no difference between the two randomized groups with regard to the mentioned variables. Sixty-five point six percent allotted to spontaneous pushing used the closed glottis technique for more than half the expulsive phase. When divided into two groups according to the actual pushing technique used most, the women who used the open glottis technique had a shorter second stage of labor and gave birth to infants with lower birth weight. Recommendation to use spontaneous bearing down efforts did not result in fewer complications to the infant or the mother than recommendation of expulsion by the closed glottis technique.