Intervention Group
(Spontaneous pushing with pursed lips breathing)
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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.
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Control Group
(Directed pushing)
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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!”.
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