Effect of Spontaneous versus Directed Pushing during Second Stage of Labor on Pelvic Floor Morbidity among Primiparous Women..

Abdel -Salam Elkerdawy, Al- Zahraa; Abdel-Salam Ramadan, Soad; Mohamed Emam, Afaf; Abd El-wahab Afifi Araby, Ola

doi:10.21608/jnsbu.2025.435251

Effect of Spontaneous versus Directed Pushing during Second Stage of Labor on Pelvic Floor Morbidity among Primiparous Women..

Authors

¹ Teacher at Minyet El-nasr Secondary School for Nursing

² Professor of Obstetrics and Gynecology Nursing, Faculty of Nursing, Benha University

³ Assistant professor of Obstetrics and Gynecological Nursing, Faculty of Nursing, Benha University

10.21608/jnsbu.2025.435251

Abstract

Background: The second stage of labor is critical for maternal and fetal outcomes and is influenced by various factors, including the pushing techniques used by the nurses or obstetricians. Aim: To evaluate effect of spontaneous versus directed pushing during the second stage of labor on pelvic floor morbidity among primiparous women. Design: A quasi-experimental design (“two groups post-test only”) was used to fulfill this study. Setting: The study was conducted in the labor unit in the obstetrics and gynecological department at Banha University Hospitals. Sample: A purposive sample of 140 primiparous was divided into a directed pushing group (70) and a spontaneous pushing group (70). Tools: Two tools were used for data collection: A structured interviewing questionnaire sheet (general characteristics, and current labor history) and pelvic floor morbidity questionnaires (fecal incontinence severity index, pelvic floor distress inventory questionnaire, and pelvic floor impact questionnaire). Result: There was a statistically significant difference between spontaneous and directed pushing groups regarding the current labor history (amniotic fluid characteristics, episiotomy, perineal condition, mode of vaginal birth, and duration of 2^nd stage of labor). Also, there was a high statistically significant difference regarding the total mean scores of pelvic floor morbidity questionnaires (spontaneous pushing group had more favorable outcomes regarding current labor history and total mean scores of pelvic floor morbidity than directed pushing group). Conclusion: Spontaneous pushing during 2^nd stage of labor had favorable outcomes related to pelvic floor morbidity and better labor outcomes than direct pushing. Recommendation: Establishing policy in healthcare settings that support spontaneous pushing to allow primiparous women to respond to the body’s natural urges to facilitate better labor outcomes.

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