Ask an answerable question (PICO)：
Valsalva maneuver is a common method used by vaginal-delivery women in the second stage of labor. However, Valsalva maneuver will wear out the maternity, cause both maternal and neonatal damage, and even increase the rate of device-assisted delivery; meanwhile, it also results in rapid and intense descending of the fetal head which raises the damage level of perineum, cervix and urinary tract.
The review of this article indicates that using spontaneous pushing is able to slow down the descending of fetal head and allows perineal muscles to slowly extend, which further reduced the pressure on the anterior vaginal wall, the supporting cervical ligament and connective tissues. Therefore, through looking into this article, we expect to provide a caring principle for clinical staff and professions.
The Method and Analysis of Literature Review：
This article is demonstrated in EBM ,setting “Second Labor Stage”,” Spontaneous pushing” , “bearing down pushing”, “Valsalva maneuver”, “breath-holding pushing”, “directed pushing”, “perineal laceration”,”perineal wound” as keywords in PICO; Under Brin logics, the keywords were included in the Union of OR and the Intersection of AND, and using cut-off words for searching.
Searching in databases such as Cochrane library, PubMed, CINAHL, Taiwan journal article index system and Huayi online library while adjusting the searching settings, 47 related documents were included. After excluding duplication, un-related titles and abstracts, two randomized experimental studies that met the subject were reviewed.
Critical Appraisal：
According to the clinical research evidence level of "Oxford Centre for Evidence- Based Medicine 2011 Levels of Evidence", the Critical Appraisal Skill Programme (CASP) was used as a reviewing tool to pull out article reviews on three aspects: validity, importance, and practicability. The reviewed articles are all rated as Level 2.
Results, Conclusions and Recommendations：
After article reviewing and evaluation, both documents revealed that there was no significant difference in perineal laceration between Spontaneous pushing and Valsalva maneuver in the second stage of labor, however, the former allows maternity to exhale or let out sound depending on her own feeling, not only does this relax the perineal muscles, reduce maternal exhaustion, but allow more maternal control in delivery process, and by doing so, it improves their satisfaction, reduces postpartum urinary incontinence rate effectively and furthermore, improves the quality of life.
