title: Factors related to perineal trauma in childbirth.
abstract: We conducted an observational cohort study in three nurse-midwifery services to identify patient characteristics and clinical care measures related to perineal trauma at birth. Data were collected on all women who began care with a nurse-midwife in labor, using an adaptation of the Nurse-Midwifery Clinical Data Set (n = 3,049). Study variables included demographics, perineal management techniques and position for birth, and other intrapartum care and events. Univariate and multivariate analyses showed that episiotomy was strongly related to fetal bradycardia, prolonged second stage, ethnic status, and maternal education level. Warm compresses and flexion/counter-pressure to slow delivery were protective. Spontaneous lacerations were influenced by these factors as well. The lateral position for birth was protective, and use of oils or lubricants and the lithotomy position increased lacerations, Multisite studies in nurse-midwifery practices may provide an ideal means of determining effective care measures in healthy populations.
authors.affiliation: University of New Mexico College of Nursing, Albuquerque 87131-1061, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Albers
authors.forename: D
authors.initials: D
authors.lastname: Anderson
authors.forename: L
authors.initials: L
authors.lastname: Cragin
authors.forename: S M
authors.initials: SM
authors.lastname: Daniels
authors.forename: C
authors.initials: C
authors.lastname: Hunter
authors.forename: K D
authors.initials: KD
authors.lastname: Sedler
authors.forename: D
authors.initials: D
authors.lastname: Teaf
mesh_terms: D000328:Adult; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods*; D004841:Episiotomy; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods*; D009721:Nurse Midwives; D007744:Obstetric Labor Complications / Q000209:etiology* / Q000451:nursing*; D010502:Perineum / Q000293:injuries*; D011187:Posture; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors