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Martín-Vázquez C, Goás-Gómez N, Calvo-Ayuso N, Rosón-Matilla L, Quiroga-Sánchez E, García-Fernández R. Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives. Healthcare (Basel) 2024; 12:441. [PMID: 38391816 PMCID: PMC10888027 DOI: 10.3390/healthcare12040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences.
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Affiliation(s)
- Cristian Martín-Vázquez
- Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Noelia Goás-Gómez
- Centro de Salud Vilalba, Servizo Galego de Saúde (SERGAS), 27800 Lugo, Spain
| | - Natalia Calvo-Ayuso
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | | | - Enedina Quiroga-Sánchez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
| | - Rubén García-Fernández
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Campus de Ponferrada, Universidad de León, 24401 León, Spain
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal
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Heim MA, Makuch MY. Evaluation of a short in-person and online antenatal educational intervention for high-risk pregnant women linked to antenatal consultation. Eur J Midwifery 2024; 8:EJM-8-03. [PMID: 38239277 PMCID: PMC10795506 DOI: 10.18332/ejm/175927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/20/2023] [Accepted: 12/27/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The aim of this study was to evaluate a short educational intervention that focused on labor pain (through visual analogue scale, VAS), postpartum anxiety, and birthing experience before and during the SARS-CoV-2 (COVID-19) pandemic. METHODS This was a quasi-experimental study conducted between November 2019 and May 2021 in Brazil in 100 women with a high-risk pregnancy in the third trimester of pregnancy with an intervention group with in-person or virtual sessions (during the COVID-19 pandemic) and a non-intervention group. The antenatal intervention included breathing and relaxation techniques, upright positions, and information about labor. For evaluation, an antenatal questionnaire, State-Trait Anxiety Inventory (STAI) and a postpartum questionnaire were used. For data analysis, Student's t-test, chi-squared and Fisher's exact tests, ANOVA, bivariate, and multivariate regression analysis, were used. RESULTS When comparing the women in the intervention group to the non-intervention group, it was observed that the latter group reported higher fear of pain at labor during antenatal consultations (p<0.013); more women needed analgesia at 0-4 cm dilation (17/40) (p<0.018); the duration of labor was ≥12 hours (37/50) (p<0.037); while the intervention reported having a regular, good or excellent labor period (36/50) (p=0.014). The multiple regression analysis for labor pain showed a significant relationship between mode of delivery (cesarean delivery: RR; SE -21.43; 5.32, p<0.001) and labor pain, and good satisfaction with labor (RR; SE -13.86; 6.40, p=0.033). CONCLUSIONS Women from the intervention group had more satisfaction and less pain during labor than women from the non-intervention group.
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Affiliation(s)
- Maria A. Heim
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Sao Paulo, Brazil
| | - Maria Y. Makuch
- Department of Obstetrics and Gynecology, University of Campinas Faculty of Medical Sciences, Sao Paulo, Brazil
- Campinas Reproductive Health Research Center, Sao Paulo, Brazil
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Borer H, Dubovi I. Fostering childbirth education on upright positions and mobility during labor in nulliparous women. BMC Pregnancy Childbirth 2023; 23:870. [PMID: 38104069 PMCID: PMC10724979 DOI: 10.1186/s12884-023-06166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Upright labor positions and movement during labor have a positive effect on childbirth, yet the predominant labor positions are still horizontal. Therefore, it is important to explore how it is possible to improve childbirth education, particularly its instructional design, to strengthen women's self-efficacy toward the use of upright positions and mobility during labor. The aim of the study was to evaluate the impact of an instructional approach based on a cognitive engagement ICAP (Interactive, Constructive, Active, Passive) framework on the development of knowledge, attitudes, and self-efficacy expectations toward upright positions and mobility during labor. METHODS A prospective quasi-experimental study was conducted among nulliparous women from the ultra-orthodox Jewish community (n = 74). While the control group (n = 34) participated in routine childbirth education, the intervention group (n = 36) learned with childbirth education that included interactive and constructive cognitive engagement activities. Participants in both groups completed a set of questionnaires regarding knowledge, attitudes, and self-efficacy. RESULTS The post-test analysis revealed that women in the intervention group compared to the control group gained significantly higher knowledge scores (p < 0.05), more positive attitudes (p < 0.001), and stronger self-efficacy expectations toward upright positions and mobility during labor (p < 0.01). CONCLUSIONS The findings suggest that by fostering women's cognitive engagement levels during childbirth education toward the interactive and constructive modes of the ICAP framework, women's self-efficacy to move during labor and to use upright positions can be induced. These results can serve as a foundation to improve the overall effectiveness of childbirth instruction. TRIAL REGISTRATION The study was registered retrospectively.
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Affiliation(s)
- Hanna Borer
- Nursing Department, Faculty of Medicine, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Ilana Dubovi
- Nursing Department, Faculty of Medicine, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, 69978, Israel.
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Fu L, Huang J, Li D, Wang H, Xing L, Wei T, Hou R, Lu H. Effects of Using Sitting Position versus Lithotomy Position during the Second Stage of Labour on Maternal and Neonatal Outcomes and the Childbirth Experience of Chinese Women: A Prospective Cohort Study. Healthcare (Basel) 2023; 11:2996. [PMID: 37998488 PMCID: PMC10671611 DOI: 10.3390/healthcare11222996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Existing research concerning the effects of the sitting birth position during the second stage of labour on maternal and neonatal outcomes remains controversial, and there is a lack of studies to explore its effect on the childbirth experience. The objective of this study is to explore whether the sitting birth position would influence maternal and neonatal outcomes, as well as the childbirth experience. The prospective cohort design was conducted in the study from February to June 2023, a total of 222 women (including primiparous women and multiparous women) were enrolled in our study, and they were divided into the sitting position cohort (n = 106) or the lithotomy position cohort (n = 116). The pre-designed questionnaire and Childbirth Experience Questionnaire (CEQ) were used for data collection during hospitalisation. Chi-square, Fisher's exact test, t-tests, or the Mann-Whitney U test were utilised to assess differences between groups. Multivariate linear regression and logistic regression were employed to control possible confounders. The study found that primiparous women in the sitting position cohort had a shorter duration of the second stage of labour, higher spontaneous vaginal birth rates, lower episiotomy rates, and a better childbirth experience (p < 0.01). After adjusting for confounding factors through multiple linear and logistic regression analyses, the results remained consistent with those reported above. No neonate in each cohort had Apgar scores at 1 min and 5 min postpartum less than 7 or a Cord artery pH less than 7.00, regardless of parity. Based on the findings, we recommend that women could take the sitting birth position into account when giving birth for a positive childbirth experience, especially for primiparous women. The study could also serve as a reference for healthcare providers in the management of childbirth positions and the development of high-quality maternal care.
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Affiliation(s)
- Li Fu
- School of Nursing, Peking University, Beijing 100191, China;
| | - Jing Huang
- Division of Care for Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Danxiao Li
- Department of Obstetrics and Gynaecology, Peking University People’s Hospital, Beijing 100044, China; (D.L.); (L.X.)
| | - Huide Wang
- Department of Obstetrics, Beijing Hospital, Beijing 100730, China; (H.W.); (T.W.)
| | - Lili Xing
- Department of Obstetrics and Gynaecology, Peking University People’s Hospital, Beijing 100044, China; (D.L.); (L.X.)
| | - Tao Wei
- Department of Obstetrics, Beijing Hospital, Beijing 100730, China; (H.W.); (T.W.)
| | - Rui Hou
- School of Nursing, Peking University, Beijing 100191, China;
| | - Hong Lu
- School of Nursing, Peking University, Beijing 100191, China;
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Zang Y, Huang J, Zhang H, Sun K, Li X, Wang D, Wei T, Xing L, Fu L, Hou R, Lu H. Implementation of the Practice Programme for Upright Positions in the Second Stage of Labour and the birth experience of Chinese women: A qualitative study. Midwifery 2023; 125:103801. [PMID: 37657132 DOI: 10.1016/j.midw.2023.103801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/08/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Upright positions in the second stage of labour are recommended by many international organizations. However, they have not been widely used worldwide, especially in China. One of the important factors is the absence of a practice programme based on the best available evidence. We thus developed a Practice Programme for Upright Positions in the Second Stage of Labour following the UK Medical Research Council framework. Under the guidance of the programme, whether the use of upright positions can improve the maternal birth experience is a question of great concern. This study aimed to explore the birth experience of Chinese women who adopted upright positions in the second stage of labour. DESIGN This qualitative descriptive study was conducted as part of an implementation study that developed an evidence-based intervention and used strategies to integrate the evidence-based intervention into routine obstetric clinical practice. SETTING The maternity department of a tertiary comprehensive hospital in Hebei Province, China. PARTICIPANTS Semi-structured interviews with twelve eligible women who adopted upright positions in the second stage of labour were conducted between March and April 2022. Qualitative data were analyzed by using conventional content analysis. FINDINGS The average age of included women was 26.5 ± 3.5 years, and ten of them were primiparous women. Eight women adopted epidural analgesia during labour to relieve labour pain. All women gave birth in at least one type of upright position in the passive second stage of labour and adopted the semi-recumbent position in the active second stage of labour. Through conventional content analysis, we found that the use of upright positions in the second stage of labour could possibly promote an overall positive birth experience. Women giving birth in upright positions generally perceived they were more involved in their birthing process, and had greater physical and mental capacity to cope with childbirth. KEY CONCLUSIONS Women have a positive birth experience when using upright positions in the second stage of labour. IMPLICATIONS FOR PRACTICE This study suggests upright positions could improve women's birth experience and have the potential to be widely applied in clinical practice.
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Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing 100191, China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Kejuan Sun
- Department of Nursing, The First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaodan Li
- Department of Nursing, Peking University People's Hospital, Beijing, China
| | - Dehui Wang
- Department of Obstetrics, Beijing Hospital, Beijing, China
| | - Tao Wei
- Department of Obstetrics, Beijing Hospital, Beijing, China
| | - Lili Xing
- Department of Obstetrics, Peking University People's Hospital, Beijing, China
| | - Li Fu
- School of Nursing, Peking University, Beijing 100191, China
| | - Rui Hou
- School of Nursing, Peking University, Beijing 100191, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing 100191, China.
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Boopalan D, Vijayakumar V, Ravi P, shanmugam P, Kunjumon B, Kuppusamy M. Effectiveness of antenatal yoga in reducing intensity of labour pain: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100214. [PMID: 37753519 PMCID: PMC10518512 DOI: 10.1016/j.eurox.2023.100214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/22/2023] [Accepted: 07/04/2023] [Indexed: 09/28/2023] Open
Abstract
Background Yoga during pregnancy was found to be beneficial in various aspects of pregnancy including pain management during the time of labour. The current systematic review and meta-analysis aims to assess the effectiveness of antenatal yoga practices in reducing pain during the time of labour. Methods We searched electronic databases such as PubMed, Embase, Cochrane Library, and Web of Science, till January 2023. Randomized controlled trials (RCTs) which measured the effects of antenatal yoga practices on pain management during labour were included. The main outcome was the pain intensity measured with any validated questionnaire. The methodological quality of included studies was evaluated by using a risk-of-bias assessment tool developed by the Cochrane Collaboration. For the effect size, standardized mean differences (SMDs) with a 95% confidence interval (CI) were generated with a random effect model using R software (version 4.2.2). Results Eight studies including 576 antenatal women between the age of 14 and 40 years were included. Results of this meta-analysis showed that yoga is effective in reducing labour pain (SMD: -1.34 95% of CI: -1.86, -0.81) with significant heterogeneity among the studies (I2 73%, p < 0.0008). Conclusion Antenatal yoga can be a promising intervention in the field of obstetrics to reduce the intensity of labour pain. However, we are still in need of RCT with a large sample size to confirm the reliability of the present meta-analysis.
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Affiliation(s)
- Deenadayalan Boopalan
- Senior Research Fellow, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Venugopal Vijayakumar
- Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr. MGR Medical University, Chennai, India
| | - Poornima Ravi
- Senior Research Fellow, Sri Ramachandra Institute of Higher Education and Research. Chennai, India
| | - Poonguzhali shanmugam
- Department of Community medicine, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr. MGR Medical University, Chennai, India
| | - Bincy Kunjumon
- Department of Community Medicine, SRM Medical College Hospital and Research Centre, SRMIST, Chennai, India
| | - Maheshkumar Kuppusamy
- Department of Physiology, Govt. Yoga & Naturopathy Medical College & Hospital, The Tamilnadu Dr. MGR Medical University, Chennai, India
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Zang Y, Hu Y, Lu H. Effects of different techniques during the second stage of labour on reducing perineal laceration: An overview of systematic reviews. J Clin Nurs 2023; 32:996-1013. [PMID: 35253295 DOI: 10.1111/jocn.16276] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 12/28/2022]
Abstract
AIM AND OBJECTIVE To summarize the evidence on the effects of different techniques during the second stage of labour on reducing perineal laceration depending on available systematic reviews to provide optimal evidence for decision-making. BACKGROUND Preventing perineal laceration has been considered an important part of improving women's health. Various techniques have been used to prevent perineal laceration during the second stage of labour. However, systematic reviews evaluating the effects of different techniques on reducing perineal laceration show inconsistent results. DESIGN Overview of systematic reviews. METHODS Five English and four Chinese databases were systematically searched for relevant systematic reviews and meta-analyses published between 1 January 2016 and 31 August 2021. The quality of the included reviews was assessed by the AMSTAR 2 tool. A narrative synthesis was conducted to report the results of moderate-to-high quality systematic reviews. The overview was reported according to the PRISMA statement. RESULTS Eighteen reviews were included, of which four reviews had moderate-to-high methodological quality. Perineal massage and warm compresses significantly decreased the incidence of third- or fourth-degree perineal laceration (moderate-quality evidence). Hands-off technique had no impact on perineal laceration (low-to-moderate quality evidence). Ritgen's manoeuvre could reduce the incidence of first-degree perineal laceration but increase the incidence of second-degree perineal laceration (very low-quality evidence). Spontaneous pushing (low-quality evidence) and delayed pushing (moderate-quality evidence) had no impact on the incidence of third- or fourth-degree perineal laceration. Upright positions did not increase the risk of third- or fourth-degree perineal laceration (very low- to low-quality evidence) but increased the risk of second-degree perineal laceration for women without epidural analgesia (low-quality evidence). CONCLUSIONS Perineal massage and warm compresses could be the better choice for preventing perineal laceration in the second stage of labour. RELEVANCE TO CLINICAL PRACTICE Midwives and obstetricians could use perineal massage and warm compresses to prevent perineal laceration and should consider women's preferences and experience with perineal techniques.
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Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Yinchu Hu
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
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Satone PD, Tayade SA. Alternative Birthing Positions Compared to the Conventional Position in the Second Stage of Labor: A Review. Cureus 2023; 15:e37943. [PMID: 37223195 PMCID: PMC10202683 DOI: 10.7759/cureus.37943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
The position in which the woman delivers has a lot of impact on the ease of delivery. Women's satisfaction with their birthing experience and the care they receive is significantly impacted by the fact that giving birth is frequently a challenging experience. Birthing positions refer to various postures which can be assumed at the time of delivery by a pregnant woman. Currently, the majority of women give birth either while lying flat on their backs or in a semi-sitting position. Upright positions, which include standing, sitting, or squatting along with side-lying and hands-and-knees, are less common birth positions. Doctors, nurses, and midwives are among the most important healthcare professionals, having a significant influence in deciding which position the woman will give birth in and on the physiological and psychological effects of the experience of a woman in labor. There isn't much research to back up the best position for mothers during the second stage of labor. This review article aims to review and compare the advantages and risks of common birthing positions and know about the knowledge of alternative birthing positions among pregnant women.
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Affiliation(s)
- Prasiddhi D Satone
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Surekha A Tayade
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Séris M, Fritz J, Montoya A, Lamadrid-Figueroa H. AMBAR: A midwifery-led training program to improve obstetric and neonatal practices among low-risk births in Mexico. Birth 2023; 50:151-160. [PMID: 36529703 DOI: 10.1111/birt.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Birth care in Mexican health institutions is highly medicalized and of poor quality because of the prevalence of outdated and dangerous practices. AMBAR-a training program for health care providers on the use of evidence-based midwifery practices-was implemented during 2016-2018 and evaluated to assess the impact of training on key practices. METHODS For this mixed-methods study, we evaluated the effects of a training program implemented in three public hospital networks in Mexico. Qualitative data were collected and integrated into the program before evaluating the effects of the intervention on 10 birth practices, 5 beneficial and 5 potentially harmful. Quantitative data on birth practices and covariates were collected at six time points (baseline and 5 follow-ups) in a final sample of 330 direct observations. Effect estimates were obtained by longitudinal logistic and Poisson regression models, adjusted for confounding variables. RESULTS AMBAR had a significant effect on 4 of the 10 birth practices that were evaluated. Beneficial practices, such as skin-to-skin contact (P = 0.003) and delayed cord clamping (P = 0.039), increased significantly. Harmful when overused birth practices, such as vaginal examinations (P = 0.001), and cesarean birth (P < 0.001) decreased significantly. CONCLUSIONS Midwifery-based training programs for health care providers can have an impact on the quality of care of birthing people and newborns, increasing the use of evidence-based practices and decreasing frequently overused practices.
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Affiliation(s)
- Marina Séris
- School of Public Health of Mexico, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Jimena Fritz
- Department of Perinatal Health, National Institute of Public Health (INSP), Cuernavaca, Mexico
| | - Alejandra Montoya
- Department of Perinatal Health, National Institute of Public Health (INSP), Cuernavaca, Mexico
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Hacıvelioğlu D, Tavşanlı NG, Şenyuva İ, Kosova F. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial. Open Med (Wars) 2023; 18:20230633. [PMID: 36852266 PMCID: PMC9961962 DOI: 10.1515/med-2023-0633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/12/2022] [Accepted: 12/11/2022] [Indexed: 02/26/2023] Open
Abstract
To evaluate the effect of delivery in a vertical birth chair (VBC) and traditional delivery table (DT) supported by women's movement during labor on the labor process, fetal outcome, maternal hormone levels, birth comfort, and satisfaction. This randomized controlled trial was conducted with 1:1:1 allocation. Group 1: in the VBC in upright position, Group 2: on the DT in supine position, these groups supported by freedom of movement, control group: on the DT in supine position, labor in bed. The duration of second stage of labor was not different between the groups (p = 0.246). The occurrence of instrumental birth, episiotomy, and perineal laceration was also not different among the groups (p = 0.772, p = 0.953, and p = 0.124). The use of uterotonic was observed in control group (p = 0.001). 1 and 5 APGAR scores of newborns were not different in all groups (p = 0.121, p = 0.268). The lowest pain score was observed in Group 1 (p = 0.001). Birth comfort and satisfaction were higher in Group 1 (p = 0.001 and p = 0.001). Decreased postpartum prolactin levels and increased postpartum oxytocin levels were observed in the control and Group 1 (p = 0.004, p = 0.006). Freedom of movement during labor and delivery using VBC in upright position can play birth-promoting and supporting role. There were no negative effects on the fetal outcome.
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Affiliation(s)
| | - Nurgül Güngör Tavşanlı
- Faculty Midwifery Department, Manisa Celal Bayar University Health Science, Manisa, Turkey
| | - İrem Şenyuva
- Department of Obstetrics and Gynecology, Uşak University Medical Faculty, Uşak, Turkey
| | - Funda Kosova
- Department of Medical Biochemistry, Manisa Celal Bayar University School of Health Services, Manisa, Turkey
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de Verastegui-Martín M, de Paz-Fresneda A, Jiménez-Barbero JA, Jiménez-Ruiz I, Ballesteros Meseguer C. Influence of Laboring People's Mobility and Positional Changes on Birth Outcomes in Low-Dose Epidural Analgesia Labor: A Systematic Review with Meta-Analysis. J Midwifery Womens Health 2023; 68:84-98. [PMID: 36504479 PMCID: PMC10107776 DOI: 10.1111/jmwh.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Freedom of movement has been identified as a key issue for pregnant individuals during the birthing process, even if they opt for epidural analgesia, which has relegated people to more static positions during birth for many years. The aims of this systematic review were to evaluate the influence of mobility and positional changes on perinatal and neonatal outcomes in people in labor with epidural analgesia, describe the range of movement interventions used during the first and second stage of labor, and describe the level of motor blockade among people with low-dose epidural analgesia. METHODS Bibliographic databases (Web of Science, Cochrane, CINAHL) were consulted from December 2020 to January 2021. The articles selected were clinical trials and observational or analytical studies, the subject of which was mobilization during labor in people with epidural analgesia. The outcome measures were mode of birth, duration of labor, and extrauterine adaptation after birth. A narrative synthesis was used to describe the types of movements interventions employed during the stages of labor and the level of motor blockade among people with low-dose epidural analgesia. RESULTS Ten articles were selected (8 clinical trials, one cross-sectional study, and one quasiexperimental study), with a total sample of 6086 individuals. A meta-analysis showed nonsignificant results between groups for mode of birth (relative risk [RR], 1.00; 95% CI, 0.87-1.14), duration of labor (RR, 1.64; 95% CI, -34.57 to 37.86), and extrauterine adaptation after birth (RR, 0.86; 95% CI, 0.39-1.93). There was heterogeneity among studies in the type of movement interventions used during the first and second stage of labor. DISCUSSION Although no clear benefit was observed for mobilization in epidural labor, no detrimental effects were found either, so perinatal care providers should encourage mobilization if the laboring person so desires, throughout the entire childbirth process.
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Affiliation(s)
- Maite de Verastegui-Martín
- Doctoral Program in Health Sciences, International Doctoral School, University of Murcia, Espinardo, Murcia, Spain
| | | | - José Antonio Jiménez-Barbero
- Department of Nursing, Faculty of Nursing, University of Murcia, Espinardo, Murcia, Spain.,Research Group: Advanced Nursing Care, Instituto Murciano de Investigación Biosanitaria, Virgen de la Arrixaca
| | - Ismael Jiménez-Ruiz
- Department of Nursing, Faculty of Nursing, University of Murcia, Espinardo, Murcia, Spain.,Research Group: Advanced Nursing Care, Instituto Murciano de Investigación Biosanitaria, Virgen de la Arrixaca
| | - Carmen Ballesteros Meseguer
- Murcian Health Service, Murcia, Spain.,Research Group: Advanced Nursing Care, Instituto Murciano de Investigación Biosanitaria, Virgen de la Arrixaca
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Zang Y, Lu H. Promoting normal childbirth: Research status and application of upright positions in the second stage of labour. Int J Nurs Sci 2022; 10:129-131. [PMID: 36860708 PMCID: PMC9969065 DOI: 10.1016/j.ijnss.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/25/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China,Corresponding author.
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Zang Y, Fu L, Zhang H, Hou R, Lu H. Practice Programme for Upright Positions in the Second Stage of Labour: the development of a complex intervention based on the Medical Research Council Framework. J Nurs Manag 2022; 30:3608-3617. [PMID: 36121431 DOI: 10.1111/jonm.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to develop a Practice Programme for Upright Positions in the Second Stage of Labour to provide a reference for midwifery professionals in the standardized implementation of upright positions in clinical practice. BACKGROUND The adoption of upright positions in the second stage of labour is recommended by many international organizations, but upright positions have not been widely used and their implementation varies greatly across studies. METHODS The Practice Programme for Upright Positions in the Second Stage of Labour was developed under the guidance of the Medical Research Council framework for developing and evaluating complex interventions and the World Health Organization handbook for guideline development. Four stages were conducted: (1) establishing the intervention development group; (2) identifying a theoretical basis and forming a content framework; (3) evidence retrieval and synthesis; (4) refining and modelling the practice programme. RESULTS The content framework of the Practice Programme for Upright Positions in the Second Stage of Labour was formed based on the literature review, semi- structured interviews and expert consultation, including indications and contraindications, implementation methods, observations, potential risks and precautions. According to each item, we conducted a series of systematic reviews, and summarized the available best evidence from clinical guidelines, systematic reviews and original studies. Eventually, the Practice Programme for Upright Positions in the Second Stage of Labour was developed, integrating the findings of the iterative evidence reviews and revised by stakeholders. CONCLUSIONS This study firstly reported the development process of the Practice Programme for Upright Positions in the Second Stage of Labour, characterized by evidence-based, iteratively-processed, and highly-rigorous. The implications may guide researchers to embed the intervention normatively into clinical practice for improving maternal and infant outcomes. IMPLICATIONS FOR NURSING MANAGEMENT Facilitate systematic labour position management, and guide midwives in the successful implementation of upright positions.
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Affiliation(s)
- Yu Zang
- School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Li Fu
- School of Nursing, Peking University, Beijing, China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Hou
- School of Nursing, Peking University, Beijing, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
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Al Aryani Z, Orabi A, Fouly H. Examining the impact of upright and recumbent positions on labor outcomes in Saudi Arabia: A quasi-experiment. BELITUNG NURSING JOURNAL 2022; 8:316-324. [PMID: 37546496 PMCID: PMC10401374 DOI: 10.33546/bnj.2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/06/2022] [Accepted: 07/18/2022] [Indexed: 08/08/2023] Open
Abstract
Background Helping the woman to adopt a comfortable position during childbirth significantly affects labor changes and pain management. However, there is a lack of consensus on the impacts of different childbirth positions on labor outcomes. In addition, a scarce of studies have assessed the effects of the upright and recumbent positions on delivery outcomes, especially in the Kingdom of Saudi Arabia. Objective This study aimed to examine and compare the influence of upright and recumbent childbirth positions on birth outcomes. Methods The setting was the childbirth unit at East Jeddah Hospital from November 2020 to March 2021. The research design was quasi-experimental, including 300 women in labor under 18-45 years. The sample includes two equal groups of 150 women: upright (experiment) and recumbent (comparison) position groups. Three tools were used to collect data: a structured interviewing questionnaire, the modified WHO partograph, and the Wong-Baker FACES® pain rating scale. Descriptive statistics, chi-square, independent t-test, and paired t-test were used for data analysis. Results Women in the recumbent position spent a longer duration in the first, second, and third stages of childbirth and had higher pain scores and less satisfaction with the assumed position than women in the upright position, with a highly significant difference (p <0.001). Conclusion Laboring women in upright positions experienced faster progress of labor, shorter duration of childbirth, less pain, and higher satisfaction than those assumed recumbent positions. This study serves as an input for midwives and nurses to enable them to offer appropriate advice to improve intrapartum care. In addition, educational programs targeting pregnant women about the positive impacts of upright position on women's birth experience are encouraged.
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Affiliation(s)
- Zahra Al Aryani
- NICU Department, King Fahad Hospital Al-Baha, Kingdom of Saudi Arabia
| | - Abeer Orabi
- College of Nursing - Jeddah, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- Maternal and Newborn Health Nursing Department, Faculty of Nursing, Cairo University, Egypt
| | - Howieda Fouly
- College of Nursing - Jeddah, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
- Obstetrics and Gynecology Nursing Department, Assiut University, Egypt
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15
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Barriers and facilitators to the implementation of a practice programme for upright positions in the second stage of labour in China: A qualitative study. Midwifery 2022; 114:103458. [PMID: 35998420 DOI: 10.1016/j.midw.2022.103458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Upright positions in the second stage of labour are recommended by many labour and birth guidelines, but they have not been widely used in China and the implementation varies greatly. Given this, we developed a Practice Programme for Upright Positions in the Second Stage of Labour (UPSSL Programme). Whether the UPSSL Programme can be translated into action in the local context is a crucial issue that needs to be further explored. This study aimed to explore barriers and facilitators to the implementation of the UPSSL Programme in the Chinese context to facilitate the integration of evidence and routine clinical practice. DESIGN A descriptive qualitative design was adopted. SETTING The study was conducted in the maternity unit of a tertiary general hospital in China. PARTICIPANTS A purposeful sampling was used to recruit midwives, obstetricians and their leaders. Data were collected through semi-structured face-to-face interviews. The Consolidated Framework for Implementation Research was used to guide the development of interview guide and the analysis of qualitative data. The study was reported following the Standards for Reporting Qualitative Research. FINDINGS Twelve eligible participants were interviewed, including eight midwives, two obstetricians, the head nurse of the delivery room, and the head of the maternity unit. Eight barriers and 10 facilitators were identified by using the directed content analysis. The barriers to implementing the UPSSL Programme were professionals' concerns about the potential risks of the programme (relative advantage), higher complexity (complexity), placement method of upright positions presented without pictures (design quality & packaging), staff shortage (cost), limited understanding of parturients' needs (patient needs & resources), lack of a training protocol for professionals (available resources), professionals' limited knowledge and skills in the programme (knowledge & beliefs about the intervention), and lack of confidence in the successful implementation of the programme (self-efficacy). KEY CONCLUSIONS Participants expressed several barriers and facilitators to implementing the UPSSL Programme in clinical practice in the Chinese context. IMPLICATIONS FOR PRACTICE The findings provide a reference for the development of targeted implementation strategies that could promote the integration of evidence and routine clinical practice, and thus facilitate the normative application and promotion of upright positions in China.
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16
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Mazzarino M, Kerr D, Morris ME. Feasibility of pilates for pregnant women: A randomised trial. J Bodyw Mov Ther 2022; 32:207-212. [DOI: 10.1016/j.jbmt.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/28/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
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Shorey S, Chan V, Lalor JG. Perceptions of women and partners on labor and birth positions: A meta-synthesis. Birth 2022; 49:19-29. [PMID: 34245040 DOI: 10.1111/birt.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The risks and benefits of different birthing positions are commonly studied, but both paternal and maternal preferences and experiences of different birth positions are not examined. Therefore, this systematic review aims to explore the perceptions of women and their partners on birthing positions during the first and second stage of labor, so that maternity health care practitioners can provide better quality patient-centered care. METHODS Six databases were searched from each database's inception through November 2020. Qualitative or mixed-methods studies exploring perceptions of women and/or their partners on birthing positions were included in the review. Key information and findings of the studies were extracted; qualitative data were meta-summarized, then meta-synthesized using thematic analysis. RESULTS Seven studies were included, and four themes emerged: (a) Influences on choice and preference; (b) mixed experiences from "pain" to "more in control"; (c) impact on postpartum health; and (d) ways to empower couples in their choice. CONCLUSIONS Women's preferences for birthing positions were influenced by a myriad of personal and socio-cultural beliefs and traditions. Findings suggest a need for health care practitioners to build better rapport and provide more culturally relevant informational support to both women and their birthing partners, so they are better able to make informed decisions on their preferred birthing position.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Level 2, Clinical Research Centre, Block MD11, National University of Singapore, Singapore, Singapore
| | - Valerie Chan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, Level 2, Clinical Research Centre, Block MD11, National University of Singapore, Singapore, Singapore
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18
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Bouille L, Sichitiu J, Favre J, Desseauve D. Assessing feasibility and maternal acceptability of a biomechanically-optimized supine birth position: A pilot study. PLoS One 2021; 16:e0257285. [PMID: 34506580 PMCID: PMC8432866 DOI: 10.1371/journal.pone.0257285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In order to manage a protracted second stage of labor, "eminence-based" birth positions have been suggested by some healthcare professionals. Recent biomechanical studies have promoted the use of an optimized supine birthing position in this setting. However, uncertainty exists regarding the feasibility of this posture, and its acceptability by women. This pilot study primarily aimed to assess these characteristics. OBJECTIVE AND METHODS In this monocentric prospective study, 20 women with a protracted second stage of labor were asked to maintain a biomechanically-optimized position for at least 20 minutes at full dilatation. This posture is similar to the McRoberts' maneuver. Maintaining the position for 20 minutes or more was considered clinically relevant and indicative of feasibility and acceptability. Satisfaction with the position was assessed using a Visual Analogue Scale (VAS). A sub-group analysis was performed to assess eventual differences between more and less satisfied patients, according to the median of patients' satisfaction scores. RESULTS Seventeen patients (85%) maintained the optimized position for at least 20 minutes. The median satisfaction score of these participants was 8 (interquartile range: 1) out of 10. No significant differences were found between the two sub-groups (satisfaction score <8 vs satisfaction score ≥8) regarding general and obstetric characteristics, as well as obstetrical and fetal outcomes. CONCLUSION The optimized position is acceptable and feasible for women experiencing a protracted second stage of labor. Further clinical studies are needed to assess the efficiency of such positions when women undergo an obstructed labor.
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Affiliation(s)
- Lisa Bouille
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Joanna Sichitiu
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Julien Favre
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Vaud, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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19
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Fruscalzo A, Cocco P, Londero AP, Gantert M. Low Back Pain during Pregnancy and Delivery Outcomes. Z Geburtshilfe Neonatol 2021; 226:104-111. [PMID: 34433210 DOI: 10.1055/a-1553-4856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate low back pain (LBP) incidence and impact throughout pregnancy in terms of women's well-being and delivery outcomes. MATERIAL AND METHODS Cross-sectional prospective study conducted on singleton pregnancies at ≥37th gestational age admitted for delivery. Localization of LBP, intensity and frequency as well as derived functional disability status were assessed with a self-reported questionnaire. Main delivery outcomes including mode of delivery, and maternal or neonatal complications were recorded. RESULTS A total of 229 women participated in the study. LBP prevalence amounted to 55.9%, with the pain already present before pregnancy in 14.0% of the cases. The pain was mostly localized in the lower back (40.6%), symphysis (23.3%), and coccyx (20.5%). Both the frequency and intensity of pain gradually increased significantly during pregnancy, reaching 20 days/month (IQR=10-30) and 6/10 points (IQR=5-8) on a visual analog scale in the 3rd trimester (p<0.05). The extent of functional impairment also progressively increased up to 39/100 points (IQR=25-55, p<0.05). Women affected by LBP during pregnancy had a higher cesarean section rate during labor than women without LBP (11.9% vs. 28.9%, p<0.05). The risk was also significant in the multivariate analysis (OR=4.0, 95%CI=1.1-15.0, p<0.05). There was no difference in the rate of operative vaginal births or in the other outcomes considered. CONCLUSIONS LBP is a common issue in pregnant women, accounting for increasing morbidity and invalidity, and leading to an increased cesarean section risk during labor.
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Affiliation(s)
- Arrigo Fruscalzo
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
| | - Paolo Cocco
- Pediatric Surgery, University of Naples Federico II School of Medicine and Surgery, Napoli, Italy and Pediatric Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Ambrogio P Londero
- Clinic of Gynecology and Obstetrics, University Hospital of Udine, Udine, Italy
| | - Markus Gantert
- Gynecology and Obstetrics, St. Franziskus-Hospital Ahlen, Ahlen, Germany
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Safety and acceptance of "Vibwife", a new moving mattress to support mobilization during labor: Result of a clinical study. Midwifery 2021; 103:103096. [PMID: 34311336 DOI: 10.1016/j.midw.2021.103096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 01/21/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine the safety and acceptance "Vibwife", a new moving mattress to support mobilization of pregnant women during labor. DESIGN The study was a prospective medical device clinical study without a control group. The study was designed in intervention phases, with safety evaluation by a safety review board after each intervention phase. SETTING The study took place at the University Hospital of Basel, Switzerland. PARTICIPANTS 50 women were included with a low risk singleton pregnancy > 37th weeks during the first stage of labor. INTERVENTION Evaluation of the safety and acceptance of women, midwives and physicians during the first stage of labor. The intervention was carried out in 3 phases. In the first phase five women in labor used the device for 10 minutes, the next 10 women for 20 minutes, and finally the next 35 women for 30 minutes. MEASUREMENTS Measurement included capturing Adverse Events (AEs) (including Adverse Device Effects (ADEs)), Serious Adverse Events (SAEs) and recording vital parameters before, during, and after intervention, as well as CTG before and after intervention. Acceptance by women, midwives and physicians was measured by questionnaires with a 4-point Likert scale and pain intensity by a discrete Visual Analogue Scale (VAS) from 0-10. FINDINGS No SAE occurred during the trial. A total of 32 AEs occurred in 25 women during the intervention or in the 30 minutes follow-up. The most frequently observed AEs were modification of blood pressure and CTG abnormalities. None of the 32 AEs led to sequels of any kind. The relationship between AEs occurrence and the use of the medical device was viewed as certain in 2 cases (6.2%), possible or likely in 8 cases (25%), and unlikely or unrelated in 22 cases (68, 7%). Overall, women, midwives and physicians reported high satisfaction with their use of the device. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The medical device "Vibwife" was judged as safe for women. Acceptance among women and health personnel was good. Considering the potential benefits of mobilization during labor, this new medical device could be a very interesting adjunct to other obstetrical tools. Particularly, women whose mobility is restrained by epidural anesthesia while giving birth could be very suitable candidates. To answer the question of efficacy, a randomized-controlled trial is required.
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21
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Zang Y, Lu H, Zhang H, Zhang X, Yang M, Huang J. Chinese midwives' perceptions on upright positions during the second stage of labour: A qualitative study. Midwifery 2021; 98:102993. [PMID: 33823359 DOI: 10.1016/j.midw.2021.102993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Upright positions are recommended by many international organizations due to their positive effects on improving birth outcomes. The effects can only be achieved when upright positions are properly adopted by women under the guidance of midwives. However, whether midwives in China have a clear understanding of upright positions during the second stage of labour is an issue that has not been explored. The aim of this study was to explore midwives' perceptions on assisting women in upright positions during the second stage of labour in the context of China. DESIGN A qualitative descriptive design was adopted. We analysed the data using the conventional content analysis and reported the study in line with the COREQ checklist. SETTING The study was conducted at the labour wards of two maternity hospitals and two general hospitals in China where the adoption of upright positions was encouraged during the second stage of labour. PARTICIPANTS Semi-structured individual interviews with 17 midwives were conducted between May and July 2020. FINDINGS Three main themes were identified: (1) safety and availability; (2) unclear method of implementation; (3) lack of knowledge of the potential risks and precautions. Midwives' perceptions were based primarily on clinical experience rather than evidence-based practice. Their perceptions on the indications and contraindications of upright positions were divergent and ambiguous. Midwives' suggested that the indications and contraindications should be adjusted in the context of China. Time limit for keeping an upright position and maternal pushing during uterine contractions were two questions that still confused midwives. Midwives lacked knowledge of the potential risks of upright positions and rarely systematically summarized the precautions. KEY CONCLUSIONS This study shows that assisting women to give birth in upright positions during the second stage of labour can be a challenge for midwives in China, and also highlights the need for clarifying the detailed implementation methods of upright positions in the context of China by evidence-based approaches. IMPLICATIONS FOR PRACTICE An evidence-based protocol for implementing upright positions during the second stage of labour should be developed to guide midwives' practice and facilitate the successful use of upright positions in China.
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Affiliation(s)
- Yu Zang
- School of Nursing, Peking University, Beijing, China; School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China.
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoli Zhang
- Department of Obstetrics and Gynaecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Minghui Yang
- Department of Obstetrics and Gynaecology, the First Hospital of Kunming Medical University, Kunming, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
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Pizzagalli F. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Maternal postures during the second stage of labour, delivery techniques and perineal protection]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:931-943. [PMID: 33011376 DOI: 10.1016/j.gofs.2020.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess maternal postures during the second stage of labour on course of labour, mode of delivery and maternal and neonatal morbidity. To describe the different techniques of spontaneous vaginal delivery and their influence on maternal and neonatal morbidity. To describe the different perineal protection techniques. METHOD Systematic review of the literature through consultation of Medline, Cochrane databases and international recommendations. RESULTS There is no particular posture that has demonstrated its superiority (Level of Evidence (LE) 2). In case of no contraindication and permanent maternal and fetal monitoring, it is recommended to encourage women to adopt the postures they consider most comfortable during the second stage of labour (Consensus agreement). There is insufficient evidence in the literature to recommend a technique for fetal head and shoulders delivery. There is not enough data in the literature to recommend the use of Ritgen maneuver (grade B), perineal massage (gradeC) or hot compresses (Consensus agreement). The abdominal expression must be abandoned (grade B). CONCLUSION The second stage of labour is a crucial time in labour that can lead to significant maternal and neonatal morbidity. It is necessary to take the greatest possible care in the supervision and management of women, especially for the perineal protection. The influence of non-medicinal techniques on the course of the second stage of labour should be studied.
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Affiliation(s)
- F Pizzagalli
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France.
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Zhang S, Dumas G, Hemmerich A. Measurement of pubic symphysis width in different birthing positions using ultrasound. J Biomech 2020; 113:110114. [PMID: 33207288 DOI: 10.1016/j.jbiomech.2020.110114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/28/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
Studies have shown that some vertical birthing positions, such as squatting and standing, may influence labour and childbirth. However, a rigorous biomechanical understanding of how different positions affect a woman's pelvis during labour is currently lacking. It was hypothesized that the position of pubic bones is affected in different positions, and thus the pubic symphysis width changes. Therefore, we measured pubic symphysis width on eleven women in their seventh to ninth months of pregnancy in different positions through three-dimensional (3D) reconstruction of pubic symphysis ultrasound images. Positions studies included those used in clinics like supine and lithotomy positions, in addition to squatting and standing, which are recommended by midwives. The results showed that the average superior and inferior pubic symphysis widths in lithotomy, squatting and standing positions were approximately 1 mm larger than those in the supine position. However, no significant difference between lithotomy, squatting and standing positions was found. The results were consistent with those of two comparable studies. A significant difference was only found between standing and squatting, standing and lithotomy in the rotation angle about the medio-lateral axis. The results suggest that positions with thigh hyperflexion and gravity effect make a difference in pubic symphysis width and might have a positive effect in childbirth. However, due to the small sample size, no definite conclusion can be drawn.
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Affiliation(s)
- Shufei Zhang
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario K7L 3N6, Canada.
| | - Geneviève Dumas
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario K7L 3N6, Canada
| | - Andrea Hemmerich
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart Street, Kingston, Ontario K7L 3N6, Canada
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Zang Y, Lu H, Zhang H, Huang J, Ren L, Li C. Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta‐analysis. J Adv Nurs 2020; 76:3293-3306. [PMID: 33009847 DOI: 10.1111/jan.14587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Yu Zang
- School of Nursing Peking University Beijing China
| | - Hong Lu
- School of Nursing Peking University Beijing China
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology The Fourth Hospital of Hebei Medical University Shijiazhuang China
| | - Jing Huang
- School of Nursing Peking University Beijing China
| | - Lihua Ren
- School of Nursing Peking University Beijing China
| | - Chunying Li
- Health Science Library Peking University Beijing China
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Dokmak F, Michalek IM, Boulvain M, Desseauve D. Squatting position in the second stage of labor: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 254:147-152. [PMID: 32966958 DOI: 10.1016/j.ejogrb.2020.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The influence of squatting during delivery on maternal and fetal outcomes remains unclear. We performed a systematic review and meta-analysis to evaluate the benefits and risks of adopting a squatting position during the second stage of labor. STUDY DESIGN Search Strategy: A systematic search in the three major electronic databases (CENTRAL, PubMed and Embase) was performed, from their respective inception dates to the 14th of December 2019, using 'squatting', and a combination of keywords to identify delivery. Eligibility criteria: Randomized controlled trials comparing squatting position to any supine position during the second stage of labor. STATISTICAL ANALYSES Risk ratio for dichotomous outcomes, mean difference for continuous outcomes, with 95 % confidence intervals. Fixed-effects meta-analysis (Mantel-Haenszel method) or random-effects model (inverse variance method), for low and high heterogeneity between trials, respectively. PROSPERO Registration number: CRD42018093244 RESULTS: Seven randomized controlled trials (n = 1219) were included. Three studies were assessed as low risk of bias, three others as moderate and one study as high risk of bias. The main limitation is the lack of reporting on the methods to achieve randomization and concealment of allocation in most of the studies. There was no difference in the duration of the second stage of labor (mean -11.09 min; 95 %CI -38.85 to 16.68). In the squatting group, the risk of caesarean section was increased (RR 2.26, 95 %CI 1.07-4.80) and the risk of instrumental delivery was decreased (RR 0.60, 95 %CI 0.45-0.81), which results in a similar probability of spontaneous delivery. There were no differences regarding the other maternal and fetal outcomes. CONCLUSIONS The available evidence does not show the squatting position during childbirth to be beneficial. As there is no evidence for or against squatting, women should be able to choose the position they prefer.
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Affiliation(s)
- Fatima Dokmak
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Irmina Maria Michalek
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Boulvain
- GHOL Hôpital de Nyon, Switzerland and University of Geneva, Nyon, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Epidurals during normal labour and birth - Midwives' attitudes and experiences. Women Birth 2020; 34:e384-e389. [PMID: 32843237 DOI: 10.1016/j.wombi.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Midwives have their own beliefs and values regarding pain during childbirth. Their preferences concerning labour pain management may influence women's choices. AIM To gain a deeper understanding of midwives' attitudes and experiences regarding the use of an epidural during normal labour. METHODS A qualitative approach was chosen for data collection. Ten in-depth interviews were conducted with midwives working in three different obstetric units in Norway. The transcribed interviews were analysed using Malterud's systematic text condensation. FINDINGS The analysis provided two main themes: "Normal childbirth as the goal" and "Challenges to the practice, knowledge, philosophy and experience of midwives". Distinctive differences in experiences and attitudes were found. The workplace culture in the obstetric units affected the midwives' attitudes and their midwifery practice. How they attended to women with epidural also differed. An epidural was often used as a substitute for continuous support when the obstetric unit was busy. DISCUSSION Midwives estimate labour pain differently, and this might impact the midwifery care. However, midwives' interests and preferences concerning labour pain management should not influence women's choices. Midwives are affected by the setting where they work, and research highlights that an epidural might lead to a focus on medical procedures instead of the normality of labour. CONCLUSION Midwives should be aware of how powerful their position is and how the workplace culture might influence their attitudes. The focus should be on "working with" women to promote a normal birth process, even with an epidural.
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Biomechanical comparison of squatting and “optimal” supine birth positions. J Biomech 2020; 105:109783. [DOI: 10.1016/j.jbiomech.2020.109783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
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Desseauve D, Pierre F, Fernandez A, Panjo H, Decatoire A, Lacouture P, Fradet L. Assessment of Pelvic-Lumbar-Thigh Biomechanics to Optimize The Childbirth Position: An "In Vivo" Innovative Biomechanical Study. Sci Rep 2019; 9:15968. [PMID: 31685875 PMCID: PMC6828717 DOI: 10.1038/s41598-019-52338-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 01/20/2023] Open
Abstract
The study aimed to assess the associations between the pelvis orientation, lumbar curve and thigh postures throughout pregnancy in a population of healthy women. Additionally, optimal mechanical birth conditions in terms of the pelvic inlet and lumbar curve were researched. The individuals' posture was assessed with three-dimensional motion analysis and the lumbar curve with the Epionics SPINE system. The association between the hip joint angles (flexion and abduction), the pelvis external conjugate, and lumbar curve position was assessed with a generalized linear mixed model (GLMM) adjusted to individuals' characteristics. Joint laxity was assessed with a modified Jobbin's extensometer. For all of the subjects, hip flexion and hip abduction were significantly associated with the angle between the external conjugate and spine, with higher correlation in the multivariate regression model. The association between hip flexion and the lumbar curve was less significant in multivariate than univariate regression analysis. Optimal birth conditions were never reached. The findings contribute to the understanding of the association between the hip position (flexion and abduction), pelvic orientation, and lumbar curve adjusted for joint laxity in healthy pregnant women. They lay the groundwork for future research in the field of obstetrical biomechanics.
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Affiliation(s)
- David Desseauve
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, Poitiers, France. .,Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France.
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, Poitiers, France
| | - Anna Fernandez
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH, Switzerland
| | - Henri Panjo
- Gender, Sexual and Reproductive Health, Centre for Research in Epidemiology and Population Health, (CESP), F-94807, Villejuif, France.,INED, F-75020, Paris, France
| | - Arnaud Decatoire
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Patrick Lacouture
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Laetitia Fradet
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
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Huang J, Zang Y, Ren LH, Li FJ, Lu H. A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci 2019; 6:460-467. [PMID: 31728401 PMCID: PMC6839002 DOI: 10.1016/j.ijnss.2019.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023] Open
Abstract
The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth. Midwives play a pivotal role in managing maternal positions during the second-stage of labor. However, there is limited evidence to support an ideal maternal position during the second-stage of labor. Further, the difference between different maternal positions might not be apparent. This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor, thereby to provide midwives evidence-based practical guidelines.
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Affiliation(s)
- Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yu Zang
- School of Nursing, Peking University, Beijing, China
| | - Li-Hua Ren
- School of Nursing, Peking University, Beijing, China
| | - Feng-Juan Li
- Maternal and Child Health Hospital of Xinjiang Uyghur Autonomous Region, Uyghur, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
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Musie MR, Peu MD, Bhana-Pema V. Factors hindering midwives' utilisation of alternative birth positions during labour in a selected public hospital. Afr J Prim Health Care Fam Med 2019; 11:e1-e8. [PMID: 31588769 PMCID: PMC6779978 DOI: 10.4102/phcfm.v11i1.2071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/22/2019] [Accepted: 06/01/2019] [Indexed: 11/24/2022] Open
Abstract
Background An evidence-based practice suggests that the birth position adopted by women during labour has a significant impact on the maternal and neonatal birth outcomes. The birth positions are endorsed by guidelines of maternity care in South Africa, which documented that women in labour should be allowed to select the birth position of their choice, preferably alternative birth positions (including upright, kneeling, squatting and lateral positions) during labour. Thus, the lithotomy birth position should be avoided. However, despite available literature, midwives routinely position women in the lithotomy position during normal vertex births, which causes several adverse maternal outcomes (namely prolonged labour, postpartum haemorrhage) and adverse neonatal outcomes (such as foetal asphyxia and respiratory compromise). Aim The aim was to explore and describe factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital. Setting A public hospital in the Tshwane district, Pretoria were used in the study. Methods This study used the qualitative, exploratory and descriptive research design. This design gathered quality information on factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital. Results The study revealed the following themes: (1) midwives’ perceptions on alternative use of birth positions and (2) barriers to utilisation of alternative birth positions. The themes were discussed and validated through the use of a literature review. Conclusion The lack of skills and training during the midwifery undergraduate and postgraduate programme contributes to the midwives being incompetent to utilise alternative birth positions during clinical practice.
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Affiliation(s)
- Maurine R Musie
- Department of Nursing Science, University of Pretoria, Pretoria.
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Desseauve D, Fradet L, Lacouture P, Pierre F. Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study. BMC Pregnancy Childbirth 2019; 19:251. [PMID: 31324160 PMCID: PMC6642516 DOI: 10.1186/s12884-019-2408-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background The squatting birth position is widely used for “natural” birth or in countries where childbirth occurs in non-medical facilities. Squatting birth positions, like others, are roughly defined so a biomechanical assessment is required with the availability of noninvasive technology in pregnant women. In practice, we can observe spontaneously two kinds of squatting birth position: on tiptoes and with feet flat. Objective To compare the impact of foot posture on biomechanical parameters considered essential in obstetrical biomechanics during a squatting birth position: on tiptoes versus with feet flat on the floor. Study design Thirteen pregnant women beyond 32 weeks of gestational age who were not in labor were assessed during squatting birth position firstly spontaneously and secondly with the foot posture that was not taken spontaneously (on the tiptoes vs with feet flat). For each position, ANGle of flexion on the spine of the plane of the pelvis external conjugate (ANGec), hip flexion and abduction, and lumbar curve were assessed using an optoelectronic motion capture system and a biomechanical model adapted from the conventional gait model as well as a measuring system of the lumbar curve. Results Spontaneously, 11 out of 13 women squatted on tiptoe at the first test. On tiptoes the hip flexion was lower than with feet flat (p < 0.02), whereas hip abduction was not significantly different (p = 0.28). A lower ANGec angle (p = 0.003) was noticed for the tiptoe position than feet flat. The lumbar curve (lordosis) was more marked for the squatting position on tiptoes than for the position with feet flat (p < 0.001). On tiptoes no woman had a pelvic inlet plane perpendicular to the spine and none had a flat back or kyphosis. No woman on tiptoes fulfilled the two conditions necessary for the position that we consider optimal. Conclusion In squatting birth position, foot posture has a biomechanical impact on lumbar curve and pelvic orientation. When comparing squatting positions (on tiptoes vs feet flat), feet flat on the ground is closer to optimal birth conditions than on tiptoes.
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Affiliation(s)
- David Desseauve
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, CHU de Poitiers, 2 rue de la Milétrie, BP 577, 86021, Poitiers, France. .,Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France. .,Faculty of Biology and Medicine, Lausanne University, 1011, Lausanne, Switzerland. .,Present Address: Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Vaudois (CHUV), 1011, Lausanne, Switzerland.
| | - Laetitia Fradet
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Patrick Lacouture
- Pprime Institute - CNRS UPR 3346, Axis RoBioSS, Poitiers University, Poitiers, France
| | - Fabrice Pierre
- Department of Obstetrics and Gynecology and Reproductive Medicine, University Hospital, Poitiers University, CHU de Poitiers, 2 rue de la Milétrie, BP 577, 86021, Poitiers, France
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Gachon B, Desseauve D. Why introducing biomechanical considerations into obstetrical management of women from pregnancy to delivery? Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- B. Gachon
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers, France
- Laboratory “Movement, Interactions, Performance” EA 4334, Faculty of Sport Sciences, University of Nantes, Nantes, France
- Institut PPrime RoBioSS Unit, Poitiers ENSMA, CNRS UPR 3346, Futuroscope, France
| | - D. Desseauve
- Department of Obstetrics and Gynecology, Poitiers University Hospital, Poitiers, France
- Institut PPrime RoBioSS Unit, Poitiers ENSMA, CNRS UPR 3346, Futuroscope, France
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Swiss Biomotion Lab, Centre Hopsitalier Universitaire Vaudois, Lausanne, Switzerland
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Hemmerich A, Bandrowska T, Dumas GA. The effects of squatting while pregnant on pelvic dimensions: A computational simulation to understand childbirth. J Biomech 2019; 87:64-74. [DOI: 10.1016/j.jbiomech.2019.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/25/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
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Affiliation(s)
- Mary Steen
- Professor of Midwifery, School of Nursing and Midwifery, University of South Australia
| | - Monica Diaz
- Research and clinical midwife, School of Nursing and Midwifery, University of South Australia and Women and Children's Hospital, Adelaide
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[Anal incontinence and obstetrical anal sphincter injuries, epidemiology and prevention]. ACTA ACUST UNITED AC 2018; 46:419-426. [PMID: 29500142 DOI: 10.1016/j.gofs.2018.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Indexed: 12/11/2022]
Abstract
Our main objectives were to identify risk factors, methods for early diagnosis, and prevention of obstetric anal sphincter injuries (OASIs), using a literature review. The main risk factors for OASIs are nulliparity, instrumental delivery, posterior presentation, median episiotomy, prolonged second phase of labor and fetal macrosomia. Asian origin, short ano-vulvar distance, ligamentous hyperlaxity, lack of expulsion control, non-visualization of the perineum or maneuvers for shoulder dystocia also appear to be risk factors. There is a risk of under-diagnosis of OASIs in the labor ward. Experience of the accoucheur is a protective factor. Secondary prevention is based on the training of birth professionals in recognition and repair of OASIs. Primary prevention of OASIs is based on training in the maneuvers of the second phase of labor; if possible, instrumental extractions should be avoided. Mediolateral episiotomy may have a preventive role in high-risk OASIs deliveries. A robust predictive model is still lacking to allow a selective use of episiotomy.
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