Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study

• Published in: Birth (Berkeley, Calif.) Vol. 44; no. 1; pp. 86 - 94
• Main Authors: Edqvist, Malin, Hildingsson, Ingegerd, Mollberg, Margareta, Lundgren, Ingela, Lindgren, Helena
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2017; John Wiley and Sons Inc
• Subjects: Adult; Anal Canal - injuries; Analgesia; Analgesia, Epidural - statistics & numerical data; birth position; Caring; Childbirth; Childbirth & labor; Cohort analysis; Episiotomy; Episiotomy - adverse effects; Episiotomy - statistics & numerical data; Female; First time; Flexibility; Health Sciences; High risk; Humans; Hälsovetenskaper; Injury Severity Score; Interventions; Maternity wards; Medicin och hälsovetenskap; Midwifery; Midwifery - methods; Midwifery - standards; midwifery intervention; Midwives; Multivariate Analysis; Nursing; Obstetric Labor Complications; Obstetrics; Obstetrics, Gynecology and Reproductive Medicine; Occult; Omvårdnad; Original; Parity; Perineal trauma; Perineum - injuries; Perineum - surgery; Pregnancy; Prospective Studies; Regression Analysis; Reproduktionsmedicin och gynekologi; Risk Factors; second-degree tears; spontaneous pushing; Sweden; two-step delivery; Women; Young Adult; Sweden; midwifery intervention; spontaneous pushing; birth position; two-step delivery; second-degree tears
• ISSN: 0730-7659; 1523-536X; 1523-536X
• DOI: 10.1111/birt.12267

Introduction Most women who give birth for the first time experience some form of perineal trauma. Second‐degree tears contribute to long‐term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second‐degree tears among primiparous women. Methods An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro‐iliac joints, and 3) a two‐step head‐to‐body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables. Results A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second‐degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33–0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention. Conclusion It is possible to reduce second‐degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low‐ and high‐risk pregnancies.