The second stage of labor, defined as the period from full cervical dilatation to fetal birth, is a critical phase in which maternal pushing techniques may significantly affect maternal and neonatal outcomes (1-5). Evidence indicates that directed Valsalva pushing may be associated with maternal apnea, increased fatigue, pelvic floor injury, and adverse fetal effects, whereas spontaneous pushing with an open glottis supports physiological birth processes (2,5-11). The World Health Organization recommends encouraging women to follow their natural pushing urges and supports the use of open-glottis pushing techniques to promote a positive childbirth experience (12).
Vocalization pushing is an open-glottis maneuver involving intentional low-tone sound production during exhalation, which may facilitate pelvic floor relaxation, improve pain management, and enhance the birth experience (9-11). However, evidence regarding the effectiveness of vocalization pushing is limited, and data from Türkiye are lacking. This randomized controlled clinical trial aims to evaluate the effects of vocalization and spontaneous pushing techniques during the second stage of labor on labor duration, pain intensity, perineal trauma, maternal fatigue, and childbirth experience.
Who can participate
Age range
18 Years
Sex
FEMALE
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion Criteria for the Study:
* Being 18 years of age or older
* Being nulliparous
* Being at term (between 38 and 42 weeks of gestation)
* Expecting a vaginal delivery
* Having a singleton pregnancy
* Presenting in vertex position
* Estimated fetal weight between 2500-4000 g
* Having had a complication-free pregnancy in terms of both mother and fetus
* Not having any perinatal risks
* Not having received any analgesia or anesthesia to relieve pain and fatigue during labor
* Being able to read, understand, and write Turkish
* Voluntarily agreeing to participate in the study
Exclusion Criteria:
* Being multiparous
* Having a multiple pregnancy
* Having dysphonia and hearing loss
* Being a high-risk pregnant woman
* Having any systemic, chronic, or neurological disease
* Pregnant women with fetal risk (presentation anomaly, cephalopelvic disproportion, macrosomia, SGA, fetal death, fetus without gross pathology according to ultrasound)
Endpoints for Cases Included in the Study:
* Loss of the baby during labor or delivery
* Delivery by cesarean section
* Pharmacological intervention to relieve pain and fatigue during labor
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1Based on my diagnosis and history, is this trial worth exploring for me — or is there a standard treatment we should try first?
2What does this trial's phase tell us about how much is already known about its safety and benefit?
3What would taking part actually involve for me — visits, tests, time, and travel?
4What are the known and possible risks or side effects I should weigh, and how would they be monitored?
5If this trial isn't the right fit, what other options or trials would you suggest I look into?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
What they're measuring
1
Visuel Analog Scale -Pain
Timeframe: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
2
Birth Experience Scale
Timeframe: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
3
Visual Analogue Scale for Fatigue
Timeframe: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery