A Single-centre Feasibility Study, Measuring The Outcomes of Spontaneous Pushing and Directed Pushing on Maternal and Neonatal Outcomes Among Women Without Epidural Analgesia During The Second Stage Of Labour
- Publication Type:
- Thesis
- Issue Date:
- 2025
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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱
Directing a woman to push during the second stage of labour is common practice worldwide, including China, and is termed as ‘directed pushing’. However, the mechanisms and outcomes of directed pushing have been insufficiently researched. Since the 1950s, the process and outcomes of directed pushing have been questioned and debated. More recently, ‘spontaneous pushing’ which occurs when a woman pushes involuntary by following cues from her body is being evaluated with the aim to increase a woman’s control over her own labour and birth, leading to a more positive childbirth experience. Current evidence on pushing methods during the second stage of labour remains conflicting, with a lack of high-quality original trials. This study aimed to systematically review the literature on pushing strategies during labour and assess the feasibility of a future RCT comparing the effects of spontaneous and directed pushing on maternal and neonatal outcomes in the Chinese context.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀
The study was conducted using a mixed method design. Phase One included a literature review of the evidence on spontaneous and directed pushing, including a systematic review, meta-analysis and a scoping review. Phase Two consisted of a feasibility study comparing spontaneous pushing with routine directed pushing. Quantitative data collected while surveys were used to assess women’s acceptability and childbirth experience. Qualitative data were collected through interviews with midwives and were analysed using thematic analysis.
𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀
Findings revealed that spontaneous pushing was associated with reduced rates of caesarean section and a lower risk of extended episiotomy. It also identified several strategies used to facilitate spontaneous pushing. Phase Two demonstrated the feasibility and preliminary effectiveness of supporting spontaneous pushing in the Chinese context. Women’s participation rate was 43% (423/995) with an overall retention rate of 24% (102/423). Women were generally satisfied with their experience. Importantly, spontaneous pushing did not increase risks for the woman and newborn, with showed potential benefits, including less blood loss volume at the birth of the placenta (P=0.046) and one hour after postpartum (P=0.033). Midwives viewed the approach as a welcome return to a more physiological process of childbirth.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻
Supporting spontaneous pushing was found to be both feasible and effective within the Chinese context, confirming the feasibility of a future RCT to compare the outcomes of spontaneous and directed pushing. The research confirmed spontaneous pushing offers benefits for women without increasing risks. Both women and midwives found the practice as an alternative to the routine practice.
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