Effect of mother’s active pushing at cesarean delivery: a randomized controlled trial

Objective: This study aimed to evaluate the effect of maternal active pushing during cesarean section (CS) on postoperative pain, intraoperative discomfort, and the mother’s sense of control and participation. Design: A prospective, randomized controlled study. Methods: Patients were randomly assigned into two groups. In the Conventional group (n = 45), the CS was performed traditionally without maternal pushing. In the Assisted group (n = 55), patients were instructed to push during delivery. Outcomes measures included patients’ perceived pressure, pain, and sense of participation. Breastfeeding and postnatal depression were assessed using validated scales, along with maternal and neonatal outcomes, surgeon satisfaction, and operation duration. Results: Patients in the Assisted group reported significantly lower fundal pressure intensity (VAS score 3 vs. 5, P < 0.01) compared to the Conventional group. There was no significant difference in postoperative pain. However, women in the Assisted group reported a greater sense of participation (6 vs. 0, P < 0.01) and control (4 vs. 0, P < 0.05) than those in the Conventional group. No significant maternal or neonatal complications were observed. Conclusion: Maternal active pushing during CS positively impacted intraoperative experience by reducing perceived pressure and enhancing the sense of control and participation, without adverse effects on maternal or neonatal outcomes. These findings support further research with larger, multi-center studies to validate the potential benefits of this approach. Trial Registration: NCT05520580 (https://clinicaltrials.gov/ct2/show/NCT05520580).