Background: Although spontaneous and directed pushing techniques adopted during labor
have been studied during the past several decades, controversy still surrounds the results
regarding obstetric variables. Aim: The aim of this study was to compare the effect of
directed pushing versus spontaneous pushing during the second stage of labor on birth
outcome. Setting & Subject: The study was conducted in Maternity and Childhood
Hospital at Zagazig University Hospitals. It comprised a purposive sample of 200
parturient women in their second stage of labor. The study subjects were divided into equal
groups of 100 "spontaneous and directed pushing groups". Tools: three tools were used for
data collection (a structured interview sheet, physical assessment sheet, visual analogue scale,
modified fatigue symptom checklist and birth outcome sheet). Results: revealed that
spontaneous pushing had a better and positive effect on maternal vital signs. The duration of
pushing was lower in the spontaneous pushing group than directed pushing. Most of the
women in the spontaneous pushing group had significantly a lower pain index after 1 hour
from full cervical dilatation and perceived less fatigue within 1-4 hours of childbirth
(p=0.000). They also had significantly lower rates of episiotomy, perineal lacerations,
postpartum hemorrhage and cesarean section. Their newborn had the highest Apgar score at
the first and fifth minutes and none of them had fetal complications. Conclusion: It can be
concluded that improved fetal status, neonatal and maternal outcomes have been identified
when women were allowed to bear-down in response to their own natural urges rather than in
response to commands for repeated, sustained pushes using Valsalva maneuver.
Recommendations: It is recommended that; the utilization of the spontaneous pushing
technique must be encouraged, with randomized clinical trial to provide further confirmation
of the study findings.