Document Detail

Maternal position at midwife-attended birth and perineal trauma: is there an association?
MedLine Citation:
PMID:  16128969     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Most women will sustain some degree of trauma to the genital tract after vaginal birth. This study aimed to examine the association between maternal position at birth and perineal outcome in women who had a midwife-attended, spontaneous vaginal birth and an uncomplicated pregnancy at term. METHODS: Data from 3,756 births in a major public tertiary teaching hospital were eligible for analysis. The need for sutures in perineal trauma was evaluated and compared for each major factor studied (maternal age, first vaginal delivery, induction of labor, not occipitoanterior, use of regional anesthesia, deflexed head and newborn birthweight >3,500 g). Birth positions were compared against each other. Subgroup analysis determined whether birth positions mattered more or less in each of the major factors studied. The chi-square test was used to compare categorical variables. RESULTS: Most women (65.9%) gave birth in the semi-recumbent position. Of the 1,679 women (44.5%) who required perineal suturing, semi-recumbent position was associated with the need for perineal sutures, whereas all-fours was associated with reduced need for sutures; these associations were more marked in first vaginal births and newborn birth weight over 3,500 g. When regional anesthesia was used, semi-recumbent position was associated with a need for suturing, and lateral position associated with a reduced need for suturing. The four major factors significantly related to perineal trauma included first vaginal birth, use of regional anesthesia, deflexed head, and newborn weight more than 3,500 g. CONCLUSIONS: Women should be given the choice to give birth in whatever position they find comfortable. Maternity practitioners have a responsibility to inform women of the likelihood of perineal trauma in the preferred birth position. Ongoing audit of all clinicians attending births is encouraged to further determine effects of maternal birth position and perineal trauma, to investigate women's perception of comfortable positioning at birth, and to measure changes to midwifery practice resulting from this study.
Barbara Soong; Margaret Barnes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Birth (Berkeley, Calif.)     Volume:  32     ISSN:  0730-7659     ISO Abbreviation:  Birth     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-30     Completed Date:  2005-12-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8302042     Medline TA:  Birth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  164-9     Citation Subset:  IM    
Department of Maternal Fetal Medicine, Mater Mothers Hospital, Brisbane, Queensland, Australia.
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MeSH Terms
Delivery, Obstetric / methods*
Obstetric Labor Complications / epidemiology,  nursing,  prevention & control*
Odds Ratio
Perineum / injuries*
Queensland / epidemiology
Retrospective Studies
Statistics, Nonparametric

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