title: Increased blood loss in upright birthing positions originates from perineal damage.
abstract: OBJECTIVE
  To assess whether the risk of severe blood loss is increased in semi-sitting and sitting position, and if so, to which extent blood loss from perineal damage is responsible for this finding.
  
  
  METHODS
  Secondary analysis of data from a large trial.
  
  
  METHODS
  Primary care midwifery practices in the Netherlands.
  
  
  METHODS
  About 1646 low-risk women who had a spontaneous vaginal delivery.
  
  
  METHODS
  Blood loss was measured using a weighing scale and measuring jug. Logistic regression analysis was used to examine the net effects of birthing position and perineal damage on blood loss greater than 500 ml.
  
  
  METHODS
  Mean total blood loss and incidence of blood loss greater than 500 ml and 1000 ml.
  
  
  RESULTS
  Mean total blood loss and the incidence of blood loss greater than 500 ml and 1000 ml were increased in semi-sitting and sitting position. In logistic regression analysis, the interaction between birthing position and perineal damage was almost significantly associated with an increased risk of blood loss greater than 500 ml. Semi-sitting and sitting position were only significant risk factors among women with perineal damage (OR 1.30, 95% CI 1.00-1.69 and OR 2.25, 95% CI 1.37-3.71, respectively). Among women with intact perineum, no association was found.
  
  
  CONCLUSIONS
  Semi-sitting and sitting birthing positions only lead to increased blood loss among women with perineal damage.
authors.affiliation: Department of General Practice, Women Studies Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands. ank.dejonge@tno.nl
authors.forename: A
authors.initials: A
authors.lastname: de Jonge
authors.forename: M Th
authors.initials: MT
authors.lastname: van Diem
authors.forename: P L H
authors.initials: PL
authors.lastname: Scheepers
authors.forename: K M
authors.initials: KM
authors.lastname: van der Pal-de Bruin
authors.forename: A L M
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000328:Adult; D000367:Age Factors; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D010502:Perineum / Q000293:injuries*; D006473:Postpartum Hemorrhage / Q000209:etiology*; D011187:Posture; D011247:Pregnancy; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D006454:Hemoglobins