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Using the Valsalva technique during the second stage of labour

02 February 2016
Volume 24 · Issue 2


The Valsalva technique for directed pushing during the second stage of labour is an intervention still used by some health care practitioners in the UK, despite evidence suggesting that this is not the best approach to intrapartum care. Current research in this area is limited, with ambiguous findings. The latest National Institute for Health and Care Excellence (NICE, 2014) guidelines recommend that until further research is forthcoming, women should be guided by their own instinctive urge to push during the second stage and directed pushing should not be used as part of routine intrapartum care. Midwives are encouraged to ensure that women are fully informed of the latest evidence, and use their professional judgement in conjunction with the woman's individual needs and preferences while undertaking care during the second stage of labour.

The Valsalva technique of directed pushing during the second stage of labour is a childbirth intervention that has long been common practice in Western culture (Petersen and Besuner, 1997; O'Connell et al, 2001; Cooke, 2010). This intervention is often highlighted as an example of how some health professionals continue to attempt to override the physiological elements of childbirth by using practices that are no longer evidence-based (Perez-Botella and Downe, 2006). More than 50 years ago, British obstetrician Beynon (1957) was critical of the Valsalva technique, questioning why doctors and midwives believed it was their role to encourage a mother to force her baby through the birth canal as rapidly as possible.

The technique of deep breath-holding and then forceful pushing against a closed glottis during the expulsive phase of labour is widely known as the Valsalva technique, after the 18th-century doctor Antonia Valsalva who first described it (Perez-Botella and Downe, 2006). Hollins-Martin (2009) further describes the technique as ‘purple pushing’, presumably because with prolonged breath-holding the small blood capillaries in the cheek and face burst, giving a purple tinge to the face. Way (1991) describes a similar technique to increase pressure in the Eustachian tube and, as a result, reduce blockage in the inner ear. Other terms describing this particular style of second stage management include directed, coached and closed glottis pushing (Kopas, 2014).

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