Maternal Pushing TechniquesNCT07316348
Vocalization and Spontaneous Pushing in the Second Stage of Labor
A study testing The vocalization straining technique will be used. in people with Maternal Pushing Techniques and Perineal Trauma, run by Istanbul University - Cerrahpasa at 1 site in Turkey (Türkiye).
Trial summary
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). Read more about this study
- Who is it for?
- Ages 18 years and older, women onlyHealthy volunteers can take part
- Conditions the study is for
- Maternal Pushing Techniques, Perineal Trauma, Maternal Fatigue
- What is being tested?
- The vocalization straining technique will be used.
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 112 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 15 Mar 2025to 15 Mar 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- 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
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- 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
Who cannot join
- 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)
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- 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
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site
Istanbul University Cerrahpaşa
Istanbul, Ataşehir, 34758
About this study
Official title: The Effect of Vocalization and Spontaneous Pushing Techniques Used in the Second Stage of Labour on Birth Outcomes: A Randomised Controlled Trial
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.
Read the detailed description
The second stage of labor begins with complete cervical dilatation and continues until the birth of the fetus. During this phase, important physiological events occur, including increased contraction frequency and intensity, fetal descent, and rotation through the birth canal (2,5). Pushing is a physiological response that facilitates fetal expulsion through coordinated uterine contractions and maternal effort (2,5).
Two primary pushing techniques are described in the literature: Valsalva pushing, characterized by breath-holding with a closed glottis, and spontaneous pushing, performed with an open glottis following the woman's natural urge (2,3,5-9). Studies report that Valsalva pushing may lead to maternal apnea, increased fatigue, fetal head compression, pelvic floor damage, and impaired bladder function (2,7,10,11). In contrast, open-glottis pushing techniques have been associated with reduced maternal and fetal distress, protective effects on the perineum, decreased labor pain, shorter second-stage duration, higher Apgar scores, improved umbilical cord pH values, and greater maternal satisfaction (5,6,10-14).
Vocalization pushing, defined as intentional low-tone sound production (e.g., "A," "O," or "U") during exhalation, is a maneuver aimed at maintaining an open glottis during pushing (10,11). Evidence suggests that vocalization during childbirth may promote pelvic floor relaxation, reduce the severity of perineal lacerations, improve pain coping through vibrational effects, and contribute to a more positive and empowering birth experience (9-12). Despite these potential benefits, the literature contains limited high-quality evidence regarding vocalization pushing, and no clinical studies have examined its use during the second stage of labor in Türkiye.
This randomized controlled trial will compare vocalization pushing and spontaneous pushing techniques during the second stage of labor. Eligible women will be randomly assigned to either the vocalization pushing group or the spontaneous pushing group. Outcomes will include duration of the second stage of labor, pain intensity, perineal trauma, maternal fatigue, and childbirth experience. The findings are expected to support evidence-based, physiological, and woman-centered intrapartum care practices.
- Conditions
- Maternal Pushing Techniques, Perineal Trauma, Maternal Fatigue, Labor
- Being tested
- The vocalization straining technique will be used.
- Keywords
- Labor, Pain, Satisfaction, Perineal Trauma, Pushing
- Medical subject headings
- Pain, Personal Satisfaction
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
The vocalization straining technique will be used.Procedure or surgery
During the second stage of labor, vocalization pushing techniques (using the vowels A, O, and U to exhale in deep tones) will be encouraged, and the mother's pushing will be observed.
| Study group | Role | What they receive |
|---|---|---|
| ARM 2 | No intervention | No specific instructions will be given regarding how the mother should push during the second stage of labor. |
| ARM 1 | Experimental | During the second stage of labor, vocalization pushing techniques (using the vowels A, O, and U to exhale in deep tones) will be encouraged, and the mother's pushing will be observed. Receives: Procedure: The vocalization straining technique will be used. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Visuel Analog Scale -Pain
Min: 0- Max:10
Measured: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
Birth Experience Scale
Min: 42- Max:150
Measured: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
Visual Analogue Scale for Fatigue
Min: 0- Max:10
Measured: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Jan 2026
- Study start15 Mar 2025
- Primary completion20 Mar 2025
- Study completion15 Mar 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Maternal Pushing TechniquesStudies of the same condition, open and under way.
- More trials run by Istanbul University - CerrahpasaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Outcomes assessor
- Enrolment
- 112 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Istanbul University - Cerrahpasa
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Yasemin Dincel, Istanbul University - Cerrahpasa
- Investigators
- Yasemin Dinçel, Principal investigator, Istanbul University - Cerrahpasa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07316348
- Sponsor's protocol ID
- 26.2025fbu
- Status last verified
- Dec 2025
- First submitted
- 19 Dec 2025
- Last updated
- 24 Feb 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Sen E, Gunaydin S, Yilmaz T, Dinc Kaya H. The Effect of Music on Labor Pain and Duration: A Systematic Review and Meta-Analysis. Adv Mind Body Med. 2023 Fall;37(4):4-11.
PubMed 38466048Yilmaz T, Tas O, Gunaydin S, Kaya HD. The effect of Pilates on pain during pregnancy and labor: a systematic review and meta-analysis. Rev Assoc Med Bras (1992). 2023 Sep 18;69(10):e20230441. doi: 10.1590/1806-9282.20230441. eCollection 2023.
PubMed 37729226Dunmez F, Yilmaz T. The effect of using birth ball and squatting position during labor on pain, duration, and satisfaction: A randomized controlled trial. Jpn J Nurs Sci. 2024 Apr;21(2):e12580. doi: 10.1111/jjns.12580. Epub 2023 Dec 10.
PubMed 38073180Gunaydin S, Sen E, Yilmaz T, Kaya HD. Use of Transcutaneous Electrical Nerve Stimulation (TENS) in Labor Pain: An Integrative Review. Pain Manag Nurs. 2025 Feb;26(1):85-92. doi: 10.1016/j.pmn.2024.10.004. Epub 2024 Nov 12.
PubMed 39537497
Study at a glance
From the registry record, last updated by the sponsor on 24 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Vocalization and Spontaneous Pushing Techniques Used in the Second Stage of Labour on Birth Outcomes: A Randomised Controlled Trial
- ClinicalTrials.gov ID
- NCT07316348
- Acronym / sponsor ID
- 26.2025fbu
- Conditions
- Maternal Pushing Techniques, Perineal Trauma, Maternal Fatigue, Labor
- Keywords
- Labor, Pain, Satisfaction, Perineal Trauma, Pushing
- Study type
- Interventional
- Recruitment status
- Enrolling by invitation
- Enrolment
- 112 participants (estimated)
- Lead sponsor
- Istanbul University - CerrahpasaUniversity, hospital or other
- Study start
- 15 Mar 2025 (actual)
- Primary completion
- 20 Mar 2025 (actual)
- Study completion
- 15 Mar 2026 (estimated)
- First posted
- 5 Jan 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
The second stage of labor begins with complete cervical dilatation and continues until the birth of the fetus. During this phase, important physiological events occur, including increased contraction frequency and intensity, fetal descent, and rotation through the birth canal (2,5). Pushing is a physiological response that facilitates fetal expulsion through coordinated uterine contractions and maternal effort (2,5).
Two primary pushing techniques are described in the literature: Valsalva pushing, characterized by breath-holding with a closed glottis, and spontaneous pushing, performed with an open glottis following the woman's natural urge (2,3,5-9). Studies report that Valsalva pushing may lead to maternal apnea, increased fatigue, fetal head compression, pelvic floor damage, and impaired bladder function (2,7,10,11). In contrast, open-glottis pushing techniques have been associated with reduced maternal and fetal distress, protective effects on the perineum, decreased labor pain, shorter second-stage duration, higher Apgar scores, improved umbilical cord pH values, and greater maternal satisfaction (5,6,10-14).
Vocalization pushing, defined as intentional low-tone sound production (e.g., "A," "O," or "U") during exhalation, is a maneuver aimed at maintaining an open glottis during pushing (10,11). Evidence suggests that vocalization during childbirth may promote pelvic floor relaxation, reduce the severity of perineal lacerations, improve pain coping through vibrational effects, and contribute to a more positive and empowering birth experience (9-12). Despite these potential benefits, the literature contains limited high-quality evidence regarding vocalization pushing, and no clinical studies have examined its use during the second stage of labor in Türkiye.
This randomized controlled trial will compare vocalization pushing and spontaneous pushing techniques during the second stage of labor. Eligible women will be randomly assigned to either the vocalization pushing group or the spontaneous pushing group. Outcomes will include duration of the second stage of labor, pain intensity, perineal trauma, maternal fatigue, and childbirth experience. The findings are expected to support evidence-based, physiological, and woman-centered intrapartum care practices.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, care provider, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| ARM 2 | No intervention | –No specific instructions will be given regarding how the mother should push during the second stage of labor. |
| ARM 1 | Experimental | Procedure: The vocalization straining technique will be used.During the second stage of labor, vocalization pushing techniques (using the vowels A, O, and U to exhale in deep tones) will be encouraged, and the mother's pushing will be observed. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (12 listed)
- 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
Key exclusion criteria (10 listed)
- Being multiparous
- Having a multiple pregnancy
- Having dysphonia and hearing loss
- Being a high-risk pregnant woman
- Having any systemic, chronic, or neurological disease
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| The vocalization straining technique will be used.During the second stage of labor, vocalization pushing techniques (using the vowels A, O, and U to exhale in deep tones) will be encouraged, and the mother's pushing will be observed. | Procedure or surgery | ARM 1 |
Primary outcome
Visuel Analog Scale -Pain
Time frame: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
Min: 0- Max:10
Birth Experience Scale
Time frame: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
Min: 42- Max:150
Visual Analogue Scale for Fatigue
Time frame: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery
Min: 0- Max:10
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 24 Feb 2026.
- Results publication: PubMed 38466048Sen E, Gunaydin S, Yilmaz T, Dinc Kaya H. The Effect of Music on Labor Pain and Duration: A Systematic Review and Meta-Analysis. Adv Mind Body Med. 2023 Fall;37(4):4-11.
- Results publication: PubMed 37729226Yilmaz T, Tas O, Gunaydin S, Kaya HD. The effect of Pilates on pain during pregnancy and labor: a systematic review and meta-analysis. Rev Assoc Med Bras (1992). 2023 Sep 18;69(10):e20230441. doi: 10.1590/1806-9282.20230441. eCollection 2023.
- Results publication: PubMed 38073180Dunmez F, Yilmaz T. The effect of using birth ball and squatting position during labor on pain, duration, and satisfaction: A randomized controlled trial. Jpn J Nurs Sci. 2024 Apr;21(2):e12580. doi: 10.1111/jjns.12580. Epub 2023 Dec 10.
- Results publication: PubMed 39537497Gunaydin S, Sen E, Yilmaz T, Kaya HD. Use of Transcutaneous Electrical Nerve Stimulation (TENS) in Labor Pain: An Integrative Review. Pain Manag Nurs. 2025 Feb;26(1):85-92. doi: 10.1016/j.pmn.2024.10.004. Epub 2024 Nov 12.
- Individual participant dataSharing planned: No
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Yasemin Dinçel principal investigator
Istanbul University - Cerrahpasa
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing The vocalization straining technique will be used. in people with Maternal Pushing Techniques and Perineal Trauma, run by Istanbul University - Cerrahpasa at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 12 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: enrolling by invitation, as of the sponsor's last update on 24 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Visuel Analog Scale -Pain (time frame: When cervical dilation is 8-9 cm and within the first 30 minutes after delivery). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07316348, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Feb 2026.