Objective: to evaluate the efficacy of spontaneous pushing with pursed lips breathing compared to directed pushing during the second period of labor in the occurrence of episiotomy. Methods: this is a quasi-randomized clinical trial, with 62 low-risk pregnant women in the second stage of labor. They were randomly allocated in control (CG) (n = 31) and intervention (IG) (n = 31) groups. The IG performed spontaneous pushing with pursed lips breathing while the CG was oriented to perform directed pushing associated with Valsalva Maneuver (MV). Results: There was no difference between the groups regarding the occurrence of episiotomy (RR 1,1; 95%IC 1,0 to 1,2). However, there was a decrease in the duration of the maternal pushing by 3.2 minutes (MD 3,2; 95%CI 1,4 to 5,1) and a difference in maternal anxiety (Md (IQR) IG 46 (35-52), CG 51 (44-56) p:0,049), both favoring the IG. There was no difference in others maternal and neonatal outcomes Conclusions: spontaneous pushing with pursed lips breathing was effective in reducing the duration of the pushing and showed a difference in maternal anxiety, but did not decrease the occurrence of episiotomy, nor did it alter the other studied maternal and neonatal outcomes.