Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal Birth

Shorten, Allison; Donsante, Jacki; Shorten, Brett

doi:10.1046/j.1523-536x.2002.00151.x

Cited by 76 publications

(78 citation statements)

References 15 publications

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“…Some other benefits include better perineal muscle relaxation, greater feeling of control and safety over the situation, less abrupt and better transition from the uterus to the environment and a significant risk reduction of vaginal tearing (Dahlen et al, 2013;Shorten, Donsante, & Shorten, 2002;Edlich et al, 1987).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador

Rosales¹,

Ortíz-Prado²,

Alarcón³

et al. 2016

GJHS

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Objectives: Demonstrate maternal and neonatal complications reported in women giving birth in water birth compared to those conventional land births. Methods:An observational retrospective analysis of the incidence of maternal and neonatal outcomes among 358 women who deliver their newborns throughout conventional vaginal delivery and 308 women giving birth in water during 2013 in Quito, Ecuador. Maternal Age, Educational attainment, Neonatal weight, height, APGAR scores, vaginal tearing and the need to resuscitate a newborn were the variables matched for both groups.Results: Among 308 women who were scheduled to deliver their newborns in water, 73% successfully culminate in water vaginal births while 26 % required a C-section. Among the conventional birth group, only 47% ended their pregnancy vaginally as planned and 53% required a C-section.The use of oxytocin (RR: 12.9 CI 7.9 to 20.9 p<0.0001) and intentional episiotomy (RR: 13.9 CI 5.1 to 37.9 p<0.0001) are much higher among conventional birth, however, the risk to have a vaginal tearing during water labor is 3 times higher than conventional birth (RR: 2.9 CI 2.12 to 4.2 p<0.0001). In the conventional delivery cohort 3 neonatal deaths were reported while water birth no deaths reported, however, no causality of these deaths was explored due to the absence of information. Conclusions:We conclude that water birth is an effective method to deliver children as long as there is an adequate understanding of the risk and benefits of this procedure. Planning a water delivery seems to reduce the risk of using prophylactic uterotonic medication, prophylactic episiotomies and to perform unplanned C-sections. Due to higher incidence of vaginal tears, strict perianal protection during the third stage of labor is recommended.

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Section: Introductionmentioning

confidence: 99%

A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador

Rosales¹,

Ortíz-Prado²,

Alarcón³

et al. 2016

GJHS

View full text Add to dashboard Cite

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“…The greatest incidence of intact perinea was found with all-fours position, with kneeling a close second, Rates above 50% were found in the majority of studies (Altman et al, 2007, Shorten et al, 2002, Soong and Barnes, 2005.…”

Section: All-fours and Kneeling Positionsmentioning

confidence: 86%

“…Rates of 2 nd degree tear (or 1 st and 2 nd combined) was around 50% (Altman et al, 2007, Shorten et al, 2002, Soong and Barnes, 2005. Few studies considered anterior trauma but interestingly rates of labial tear were found to be lower with these positions than with waterbirth and other land birth positions , Geissbuehler et al, 2004.…”

Section: All-fours and Kneeling Positionsmentioning

confidence: 99%

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The effect of maternal position at birth on perineal trauma: A systematic review

Lodge

Haith-Cooper

2016

British Journal of Midwifery

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Perineal trauma is associated with short and long term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, no evidence examining specific maternal positions, including waterbirth and how these can influence incidence and degree of perineal trauma could be found. The evidence is important to help reduce trauma rates and improve information for women and midwives.To address this dearth in reliable evidence, a systematic review was conducted.Seven studies met the inclusion criteria. Compared to landbirth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables; sitting, squatting and using a birth-stool caused the greatest incidence of trauma.The findings of this review demonstrate further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth in order that women may be advised appropriately. However, this review suggests findings that midwives can use when discussing alternative birth positions with women.

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“…However, the evidence does show the risks and benefits for women according to the position adopted by the women during parturition. It is especially important to minimize the perineal traumas related to the birthing position (5) . Few studies have been done about the risks and benefits of birthing positions during parturition to prevent the maternal mortality attributed to perineal traumas due to different positions.…”

Section: Introductionmentioning

confidence: 99%

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

2011

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Objective:To evaluate the perineal outcomes in unconventional birth positions. Methods: A randomized clinical study. Conducted in a birth centre in the city of Itapecerica da Serra, Brazil. A sample of 158 nulliparas, divided randomly into the left lateral position (81 -experimental) and upright half-sitting (77 -control). Results: Experimental group showed less vulvar edema, 13.6% vs. 29.9%, OR 2.71 (95% IC 1.22 -6.02), episiotomy, 16.0% vs. 35.1 OR 2,46 (95% IC 1, 27 -4.74), and more labial lacerations 37,0% vs. 19,5% OR 2,43 (95% IC 1,18 -5,51). The women who adopted the upright half-sitting position had a lower risk of first-degree laceration (37,7% versus 56,8%). However, they had a higher risk of second-degree laceration and frequency of episiotomy OR 2,11 (95% IC 1,02 -4,35). The presence of vulvar edema increased the risk of spontaneous trauma and episiotomy OR 3,99 (95% IC 1, 80 -8,85). Conclusions: Our data confirmed the hypothesis that the left lateral position offers less risk of serious perineal traumas. Keywords: Obstetrical nursing; Midwifery/methods; Natural childbirth/methods; Posture; Perineum/injuries RESUMO Objetivo: Avaliar se existe associação entre o resultado perineal em posições de parto não convencionais. Métodos: Estudo clínico randomizado realizado no Centro de Parto Normal da cidade de Itapecerica da Serra, São Paulo, Brasil. A amostra foi constituida por 158 nulíparas divididas aleatoriamente na posição de parto lateral esquerda (81 no grupo experimental) e vertical semi-sentada (77 no grupo controle). Resultados: As mulheres do grupo experimental apresentaram menor edema vulvar -13,6% vs 29,9%, OR 2.71 (95% IC 1,22 -6,02), episiotomia 16,0% vs 35,1 (OR 2.46 (95% IC 1,27 -4,74) e laceração de lábios 37,0% vs 19,5% OR 2,43 (95% IC 1,18 -5,01). Na posição vertical tiveram menor risco de laceração de 1º grau -37,7% vs 56,8%. Entretanto, tiveram mais risco de laceração de 2º grau e episiotomia OR 2,11 (95% 1,02 -4,35). O edema vulvar aumentou o risco de trauma espontâneo e episiotomia OR 3,99 (95% IC 1,80 -8,85. Conclusão: Esses dados confirmam a hipótese de que a posição lateral esquerda oferece menos risco de traumas perineais graves. Descritores: Enfermagem obstétrica; Tocologia/métodos; Parto normal/métodos; Postura; Períneo/lesões RESUMEN Objetivo: Evaluar si existe asociación entre el resultado perineal en posiciones de parto no convencionales. Métodos: Estudo clínico randomizado realizado en el Centro de Parto Normal de la ciudad de Itapecerica da Serra, SP, Brasil. La muestra fue de 158 nulíparas divididas aleatoriamente en la posición de parto lateral izquierdo (81 en el grupo experimental) y vertical semi-sentada (77 en el grupo control). Resultados: Las mujeres del grupo experimental presentaron menor edema vulvar -13,6% vs 29,9%, OR 2.71 (95% IC 1,22 -6,02), episiotomía 16,0% vs 35,1 (OR 2.46 (95% IC 1,27 -4,74) y laceración de labios 37,0% vs 19,5% OR 2,43 (95% IC 1,18 -5,01).En la posición vertical tuvieron menor riesgo de laceración de 1º grado -37,7% vs 56,8%. E...

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Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal Birth

Cited by 76 publications

References 15 publications

A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador

A Retrospective Study of Maternal and Neonatal Outcomes Following Conventional and Water Birth in Ecuador

The effect of maternal position at birth on perineal trauma: A systematic review

Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study

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