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

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 interv...

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Autores principales: Edqvist, Malin, Hildingsson, Ingegerd, Mollberg, Margareta, Lundgren, Ingela, Lindgren, Helena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324579/
https://www.ncbi.nlm.nih.gov/pubmed/27859542
http://dx.doi.org/10.1111/birt.12267
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author Edqvist, Malin
Hildingsson, Ingegerd
Mollberg, Margareta
Lundgren, Ingela
Lindgren, Helena
author_facet Edqvist, Malin
Hildingsson, Ingegerd
Mollberg, Margareta
Lundgren, Ingela
Lindgren, Helena
author_sort Edqvist, Malin
collection PubMed
description 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.
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spelling pubmed-53245792017-03-08 Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study Edqvist, Malin Hildingsson, Ingegerd Mollberg, Margareta Lundgren, Ingela Lindgren, Helena Birth Original Articles 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. John Wiley and Sons Inc. 2016-11-14 2017-03 /pmc/articles/PMC5324579/ /pubmed/27859542 http://dx.doi.org/10.1111/birt.12267 Text en © 2016 The Authors. Birth published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Edqvist, Malin
Hildingsson, Ingegerd
Mollberg, Margareta
Lundgren, Ingela
Lindgren, Helena
Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
title Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
title_full Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
title_fullStr Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
title_full_unstemmed Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
title_short Midwives’ Management during the Second Stage of Labor in Relation to Second‐Degree Tears—An Experimental Study
title_sort midwives’ management during the second stage of labor in relation to second‐degree tears—an experimental study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324579/
https://www.ncbi.nlm.nih.gov/pubmed/27859542
http://dx.doi.org/10.1111/birt.12267
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