Vocalization and Spontaneous Pushing in the Second Stage of Labor

NCT07316348 | Enrolling By Invitation

• 1 other identifier: 26.2025fbu
• Study Type: interventional
• Target: 112
• Locations: 1 country
• Sites: 1

Brief 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). 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.

Conditions

Maternal Pushing Techniques; Maternal Fatigue; Labor; Perineal Trauma

Keywords

Labor; Pain; Satisfaction; Perineal Trauma; Pushing

Outcome Measures

Primary Outcomes (3)

• Visuel Analog Scale -Pain

  Min: 0- Max:10

  When cervical dilation is 8-9 cm and within the first 30 minutes after delivery

• Birth Experience Scale

  Min: 42- Max:150

  When cervical dilation is 8-9 cm and within the first 30 minutes after delivery

• Visual Analogue Scale for Fatigue

  Min: 0- Max:10

  When cervical dilation is 8-9 cm and within the first 30 minutes after delivery

Study Arms (2)

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.

Procedure: The vocalization straining technique will be used.

Interventions

The vocalization straining technique will be used. PROCEDURE

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.

ARM 1

Eligibility Criteria

• Age: 18 Years+
• Gender Eligibility Details: pregnant women
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• Istanbul University - Cerrahpasa: lead

Study Sites (1)

Istanbul University Cerrahpaşa

Istanbul, Ataşehir, 34758, Turkey (Türkiye)

Location

Related Publications (4)

• 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.

  PMID: 38466048 RESULT

• Yilmaz 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.

  PMID: 37729226 RESULT

• Dunmez 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.

  PMID: 38073180 RESULT

• Gunaydin 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.

  PMID: 39537497 RESULT

MeSH Terms

Conditions

Pain; Personal Satisfaction

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Behavior

Study Officials

• Yasemin Dinçel

  Istanbul University - Cerrahpasa

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Researcher Assistant

Study Record Dates

• First Submitted: December 19, 2025
• First Posted: January 5, 2026
• Study Start: March 15, 2025
• Primary Completion: March 20, 2025
• Study Completion: March 15, 2026
• Last Updated: February 24, 2026

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)