The Art of Pushing: Closed vs Open Glottis Pushing
Closed glottis pushing and open glottis pushing are two different techniques used during the second stage of labor, specifically when a woman is pushing to give birth. These techniques relate to how a woman breathes and pushes during contractions to facilitate the delivery of the baby. Here's an explanation of each technique:
Closed Glottis Pushing
Also known as "Valsalva maneuver" or "purple pushing," closed glottis pushing involves holding one's breath and bearing down forcefully while pushing during contractions. In this technique, the woman takes a deep breath, holds it, and pushes while closing the glottis (the opening between the vocal cords in the throat). This increases the intra-abdominal pressure, which in turn can aid in pushing the baby down the birth canal.
Advantages:
May provide more force to push the baby out quickly.
Can be effective when the baby needs to be delivered rapidly.
Disadvantages:
The increased intra-abdominal pressure can reduce blood flow to the baby and may decrease oxygen supply.
It can cause a sudden increase in blood pressure and heart rate for the mother.
There's a risk of pelvic floor trauma or tearing due to the forceful pushing.
Open Glottis Pushing
Also known as "spontaneous pushing" or "breathing down," open glottis pushing involves exhaling while pushing during contractions. In this technique, the woman takes a deep breath and then exhales slowly and steadily while pushing, allowing the glottis to remain open. This approach mimics the natural urge to bear down that many women feel during the later stages of labor.
Advantages:
Helps maintain oxygen supply for both the mother and the baby.
Reduces the risk of sudden increases in blood pressure and heart rate for the mother.
May decrease the risk of pelvic floor trauma or tearing.
Disadvantages:
May take longer for the baby to descend and be delivered compared to closed glottis pushing.
Both techniques have their pros and cons, and the choice of which technique to use often depends on the individual woman's preferences, the stage of labor, and the guidance of the healthcare provider. It's important for the healthcare team to assess the situation and adjust the pushing technique accordingly to ensure the safety and well-being of both the mother and the baby during the delivery process.
When is the best time to use one over the other?
The choice between closed glottis pushing and open glottis pushing depends on various factors, including the specific circumstances of the labor, the mother's health, and the healthcare provider's recommendations. Here's a general guideline on when each type of pushing might be used:
Closed Glottis Pushing: Closed glottis pushing, or the Valsalva maneuver, is often considered when there's a need for more forceful and efficient pushing to quickly deliver the baby. This technique may be more appropriate in situations where:
The baby needs to be delivered rapidly due to concerns about the baby's heart rate or other medical indications.
The mother is too exhausted to push effectively, and a quicker delivery is desired.
The healthcare provider determines that there's a need to expedite the delivery due to certain complications.
It's important to note that while closed glottis pushing can be effective in certain situations, there are potential risks associated with increased intra-abdominal pressure, reduced oxygen supply to the baby, and increased maternal blood pressure and heart rate. Healthcare providers carefully monitor both the mother and the baby to ensure their well-being during this technique.
Open Glottis Pushing: Open glottis pushing, or spontaneous pushing, is often considered a more physiological and gentle approach. This technique may be preferred when:
The mother is in control of her urge to push and naturally feels the need to bear down during contractions.
The baby is descending steadily and the mother is pushing effectively without holding her breath.
The healthcare provider observes that the baby's heart rate is stable and there are no indications of distress.
Open glottis pushing allows for more gradual and controlled pushing, which can help maintain oxygen supply to the baby and reduce the risks associated with increased intra-abdominal pressure. This technique is often encouraged when labor is progressing well and there are no immediate concerns about the mother's or baby's health.
Ultimately, the decision on which pushing technique to use is based on the individual circumstances of the labor and the expertise of the healthcare provider. It's important for the healthcare team to communicate with the mother and make an informed decision that prioritizes the safety and well-being of both the mother and the baby.
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