Midwives’ views on spontaneous versus Valsalva pushing during the second stage of labour

Abstract

Background: The Valsalva pushing technique encourages women to take a deep breath at the beginning of the contraction, hold it in and push for as long as they can, and is a common practice worldwide. Alternatively, women may also be encouraged to follow their instincts and push only when they feel involuntary urges. Aims: This study aimed to explore Maltese midwives’ views on spontaneous versus Valsalva pushing during the second stage of labour. Methods: A small-scale quantitative study was conducted using a self-designed, selfcompletion questionnaire. A convenience sample of 45 midwives working at a Maltese labour ward was recruited for this study. The data obtained from the closed questions were analysed manually using simple descriptive statistics, whereas content analysis was used to analyse the open-ended questions. Findings: The most frequently reported factors that influenced midwives’ choices of pushing technique suggestion were the length of the second stage of labour, the fetal condition, the women’s preference and also their general condition. Most midwives associate spontaneous pushing with better maternal and neonatal outcomes, however, participants were not aware of the negative outcomes associated with using the Valsalva pushing technique. Conclusions: This study recommends that midwives offer more information to labouring women so that the latter can make informed choices regarding their overall childbirth experience. It is recommended that until further high-quality studies are available, women should be encouraged to push and bear down according to their preferences and comfort.