wellbeing in two groups (n=45): group 1 coached closed-glot- tis pushers at full dilation; and group 2 delayed open-glottis pushers who spontaneously felt the urge to push.
Group 2 were found to produce better fetal outcomes. Group 1 had lower fetal oxygen desaturation during second stage (P=0.001) (less than normal amounts of oxygen carried by haemoglobin in the blood), and more fetal heart variable decelerations (P=0.02). No difference in Apgar scores and umbilical cord blood gases was found between groups 1 and 2. Hence, delayed pushing until the urge to push is, along with encouraged open-glottis pushing, more favourable for fetal wellbeing than coached closed-glottis pushing at imme- diate 10 cm dilatation.
Thompson (1993) in an RCT compared spontaneous pushers (n=15) and directed pushers (n=17), based on need for resuscitation and cord venous blood gas values at delivery. No adverse effects from awaiting spontaneous pushing were found. A negative correlation between length of second stage and venous cord blood pH levels at delivery in the directed pushing group was also found. Findings support that a lengthened period of directed pushing is more disadvanta- geous to the fetus than spontaneous pushing.
Yeates and Roberts (1984) studied the effects of bearing down in second stage upon the fetus/neonate. A control group were taught to bear-down while breath holding (n=5), and an experimental group (n=5) was encouraged to follow their natural instincts and bear down when they felt an invol- untary urge to push. No difference in Apgar scores between the two groups was found.
For a brief summary of the effects of ‘purple pushing’ on fetal wellbeing see Table 1.