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Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears: An Experimental Study
Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala.ORCID iD: 0000-0001-6985-6729
Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
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2017 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 44, no 1, 86-94 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2017. Vol. 44, no 1, 86-94 p.
Keyword [en]
birth position, midwifery intervention, second-degree tears, spontaneous pushing, two-step delivery
National Category
Nursing
Identifiers
URN: urn:nbn:se:miun:diva-30649ISI: 000394580700012PubMedID: 27859542OAI: oai:DiVA.org:miun-30649DiVA: diva2:1089981
Available from: 2017-04-21 Created: 2017-04-21 Last updated: 2017-04-21Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
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More styles
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