BackgroundValsalva pushing efforts sustained for longer than 5to 6 seconds lead to alterations in maternal and fetalhemodynamics, such as a lowering of maternal bloodpressure and blood flow to the placenta, decreased fetal pHand PO2,elevated PCO2,fetal academia, more nonreassuringfetal heart rate deceleration patterns with delayed recoveryto baseline, and lower Apgar scores. Compounded by theuse of a supine maternal position,which also has deleterioushemodynamic consequences these effects may becomeeven more hazardous .ConclusionThe use of valsalva during second stage of labor hasbeen associated with a significant reduction in the durationof the second stage of labor in primigravidae but there is nosignificant association between using Valsalva and adversematernal outcome ,also there was significant associationbetween coached Valsalva and Apgar score less than 7 andfetal acidosis (pH below 7.2)