Group Description
Intervention Group (Spontaneous pushing with pursed lips breathing) Nasal inspiration followed by a resisted expiration, done with pursed lips and/or half-closed teeth with a 1:3 inspiratory and expiratory ratio (I:E). Do not stimulate deep breathing but a comfortable pattern in tidal volume without excessive accessory inspiratory muscle use; Guide to begin pushing when the desire increases and not only during uterine contraction, as well as do several pushings during it; Encourage the woman to breathe freely between the pushings, encouraging several inspiratory incursions before the next pushing and expiratory delay may be encouraged; Contraindicate the use of “puppy breathing” or other breathing patterns with increased rate or prolonged apnea for more than 6 to 8 seconds; Stimulate open glottis and vocalization with deep sounds using A, O, and U vowels. Focus the expulsive effort to the abdominal region orienting “navel towards the back” if necessary, also guiding shoulder, thorax, and cervical regions relaxation during exertion; At the moment of pushing the baby out do not provide “Poop force!” guidance but rather “Relax as if you were going to pee.”; Provide positive feedback to expulsive efforts such as: “You’re doing great!”; “Very well!”; “You look great!”; “The baby is coming!”; “Congratulations!”. Also, offer guidance on the possible sensations of the woman: “You will feel your vagina opening up!” and ask for feedback about her body sensations.
Control Group (Directed pushing) Directed pushing carried out regardless of the desire to do it. Right at the beginning of a uterine contraction, take a deep breath between the pushings and then start the pushing effort with closed glottis, maintaining for 10 seconds or more. Guide according to the service team conduction: “Make a long force downwards!”; “Make poop force!”; “Inhale deeply, hold your breath, then push downwards without stopping!”; “When the contraction begins, make non-stop poop force!”; “Don’t interrupt the pushing force!”.