Traditional care of the perineum during birth. A prospective, randomized, multicenter study of 1,076 women.
OBJECTIVE
To investigate the influence of the traditional hands-on versus the innovative hands-poised method on the risk of perineal trauma during vaginal delivery and on neonatal outcomes.


METHODS
In a prospective, randomized, multicenter study, 1,161 of 1,505 women giving birth at the Departments of Obstetrics and Gynecology of the University Hospital of Vienna and Semmelweis Women's Hospital, Vienna, between February and September 1999, were randomized into the trial. In the hands-on method, the left hand of the midwife puts pressure on the infant's head, and the right hand is placed against the perineum. In the hands-poised method, the midwife guides the parturient through the birth without touching the perineum, prepared to apply light pressure on the infant's head.


RESULTS
One hundred eighty-seven of 574 women (32.5%) in the hands-on group and 180 of 502 women (35.8%) in the hands-poised group experienced perineal tears (P = .5). Sixteen women (2.7%) treated with the hands-on method developed third-degree perineal tears as compared with five women (0.9%) treated with the hands-poised method (P < .05). In the hands-on group, 103 women (17.9%) underwent episiotomy as compared with 51 cases (10.1%) in the hands-poised group (P < .01). No significant differences in neonatal outcomes were observed between the two groups.


CONCLUSIONS
Our data suggest that a policy of hands-poised care is more suitable for preserving the perineum during birth and is a safe and effective birthing alternative for women.
Mayerhofer
Klaus
K
Departments of Gynecology and Obstetrics and of Medical Computer Sciences, University of Vienna Medical School, and Semmelweis Frauenklinik, A-1090 Vienna, Währinger Gürtel 18-20, Austria. klaus.mayerhofer@akh-wien.ac.at
Bodner-Adler
Barbara
B
Bodner
Klaus
K
Rabl
Michaela
M
Kaider
Alexandra
A
Wagenbichler
Peter
P
Joura
Elmar Armin
EA
Husslein
Peter
P
D000328:Adult; D000704:Analysis of Variance; D015400:Clinical Nursing Research; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008880:Midwifery / Q000379:methods*; D009721:Nurse Midwives; D007744:Obstetric Labor Complications / Q000145:classification / Q000209:etiology / Q000517:prevention & control*; D010173:Palpation / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors