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Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma

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Abstract

Introduction and hypothesis

This study was conducted to evaluate the effects of an alternative model of birth (AMB) on the incidence of assisted vaginal delivery (AVD) and perineal trauma (PT).

Methods

One hundred ninety-nine women with epidural anesthesia were randomized to a traditional model of birth (TMB) (n = 96) or AMB (n = 103). Women in TMB pushed immediately after complete dilatation and delivered in lithotomy position. In AMB, women followed a postural changes protocol while they delayed pushing and used a specific lateral position for delivery.

Results

AMB was associated with a significant reduction in AVD compared with TMB (19.8% vs 42.1%, p < 0.001). TMB was strongly associated with AVD (OR = 4.49; p < 0.05), which, in turn, was significantly associated with nulliparity (OR = 5.52; p < 0.005) and fetal head unengaged at full dilatation (OR = 5.35; p < 0.05). AMB significantly increased the intact perineum rate compared with TMB (40.3% vs 12.2%, p < 0.001). Episiotomy rate was significantly reduced in AMB (21.0% vs 51.4%, p < 0.001).

Conclusion

A combination of postural changes during the passive expulsive phase of labor and lateral position during active pushing time is associated with reductions in AVD and PT.

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Acknowledgment

We thank the midwives of the Department of Obstetrics and Gynecology, La Paz University Hospital of Madrid, who joined the research team, for their cooperation and the physical therapist Cristina Soares for the help during the data collection period. This study was supported by Fondo de Investigación Sanitaria (FIS 05/1235), Ministerio de Sanidad y Consumo and had financial aid from Universidad Europea de Madrid, Spain.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Physiotherapy, European University of Madrid, c/ Villaviciosa de Odón s/n, 28260, Madrid, Spain

    Carolina Walker & Tania Rodríguez

  2. Department of Obstetrics and Gynecology, La Paz University Hospital, Madrid, Spain

    Ana Herranz

  3. Department of Obstetrics and Gynecology, Quiron University Hospital, Madrid, Spain

    José A. Espinosa

  4. Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain

    Emília Sánchez

  5. Department of Infirmary, Midwifery Teaching Unit, University of Barcelona, Barcelona, Spain

    Montserrat Espuña-Pons

Authors
  1. Carolina Walker
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  2. Tania Rodríguez
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  3. Ana Herranz
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  4. José A. Espinosa
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  5. Emília Sánchez
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  6. Montserrat Espuña-Pons
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Corresponding author

Correspondence to Carolina Walker.

Additional information

Funding

This study was supported by the Health Research Fund (FIS) of the Carlos III Health Institute of the Spanish Ministry of Health (PI 05/1235).

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Walker, C., Rodríguez, T., Herranz, A. et al. Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma. Int Urogynecol J 23, 1249–1256 (2012). https://doi.org/10.1007/s00192-012-1675-5

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  • DOI: https://doi.org/10.1007/s00192-012-1675-5

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