title: Perineal injury in nulliparous women giving birth at a community hospital: reduced risk in births attended by certified nurse-midwives.
abstract: BACKGROUND
  Our objective was to determine if there is a difference in rates of perineal injury sustained by nulliparous women attended by obstetricians compared with certified nurse-midwives (CNMs) at a US community hospital.
  
  
  METHODS
  We analyzed retrospective data for 2819 women who spontaneously gave birth to singleton, vertex, term, live infants between 2000 and 2005. The independent variable was attendant type (obstetrician or CNM). The main outcome variables were intact perineum, episiotomy, and spontaneous perineal lacerations. Multivariate logistic regression was used to adjust for six potential confounders: macrosomia, maternal age, epidural anesthesia, oxytocin administration, medical insurance status, and ethnicity.
  
  
  RESULTS
  The odds ratios (ORs) for obstetrician-attended births versus CNM-attended births were significant for a spontaneous minor perineal laceration versus intact perineum (OR = 1.82; 95% confidence interval [CI], 1.33-2.48), spontaneous major laceration versus intact perineum (OR = 2.29; 95% CI, 1.13-4.66), and episiotomy use versus no perineal injury, with or without extension (OR = 2.94; 95% CI, 2.01-4.29).
  
  
  CONCLUSIONS
  We found that the prevalence and severity of perineal injury, both spontaneous and from episiotomy use, were significantly lower in CNM-attended births.
authors.affiliation: Department of Genetics, Kaiser Permanente Northern California, 280 West MacArthur Blvd., Oakland, CA 94611, USA. maureenbb@gmail.com
authors.forename: Maureen
authors.initials: M
authors.lastname: Browne
authors.forename: Mark
authors.initials: M
authors.lastname: Jacobs
authors.forename: Maureen
authors.initials: M
authors.lastname: Lahiff
authors.forename: Suellen
authors.initials: S
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000767:Anesthesia, Epidural; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006771:Hospitals, Maternity / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008880:Midwifery; D015999:Multivariate Analysis; D009721:Nurse Midwives; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000451:nursing; D010120:Oxytocics / Q000008:administration & dosage; D010121:Oxytocin / Q000008:administration & dosage; D010298:Parity; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin