الفهرس 
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Abstract
The second stage of labor is a period of increased risk for the mother and the fetus. However, very few comprehensive evidence-based clinical practice guidelines are available for its management. Therefore, debate about the best practices continues to emerge for better and safe management. The ideal management of the second stage of labor should maximize the probability of vaginal delivery while minimizing the risks of maternal and neonatal morbidity and mortality. Despite this clear clinical imperative, the consensus for the optimal management of this stage is lacking, and the research underlying this question is scant.
Different approaches for management of the second stage of labor are apparent in the medical and nursing literature. Two basic pushing techniques have been described; one of which is the ‘‘directed pushing’’ and the other is the ‘‘spontaneous pushing’’. Directed pushing is the traditional method, in which women are instructed to begin pushing at full cervical dilation regardless of the urge to bear down. The woman is also instructed to take a deep breath and hold it for at least 10 seconds while pushing as hard and as long as she is able throughout the contraction. Previously, this method was thought to be the best, but it is being changed in conjunction with research showing its disadvantage on woman and fetus.
In spontaneous pushing, the woman exhales as she involuntarily pushes. This type of pushing occurs when the fetal presenting part is at +1 station and has reached the pelvic floor. Additionally, when women push spontaneously, they begin to push from their resting respiratory volume, and they push multiple times (3–5) per contraction for 3 to 5 seconds per pushing effort, followed by about 2 seconds of breaths. The pushing efforts in this type vary in intensity and frequency with each contraction.
In the past century, it has been the norm for laboring women in the hospital to engage in directed pushing during the second stage of labor. The goal has been to push forcefully to assist with fetal descent. In recent years, there has been an increased appreciation of and interest in the physiological approach to labor with less emphasis placed on time limitations. The spontaneous pushing method has been found to have advantages over directed pushing. It has fewer maternal complications such as change in blood pressure, less fatigue, greater perineal integrity and higher maternal satisfaction. The spontaneous pushing has also fewer fetal complications including acidosis and heart rate alterations. Nonetheless, the spontaneous pushing method is not widely used in maternity units. Therefore, this study was conducted to compare between spontaneous versus directed pushing during the second stage of labor on birth outcome among primiparae.
The study was conducted at labor and delivery unit of Abu EL-Matamer General Hospital affiliated to Ministry of Health in El-Beheira Governorate. The study comprised a convenient sample of 80 parturients in their second stage of labor according to the following criteria: age from 20 - 35 years, primigravida, singleton pregnancy, has no knowledge about pushing techniques, weeks of gestation (38-42 weeks), vertex presentation, at the end of the first stage of labor, no oxytocics and epidural analgesia, no maternal and fetal complications that may affect the second stage of labor as well as willing to participate in the study. The study subjects were randomly divided into two equal groups of 40 parturients (spontaneous and directed pushing groups).