title: Use of  manual techniques for perineal support in Norwegian maternity departments.
abstract: BACKGROUND
  The use of supporting techniques to protect the perineum in the last phase of birth is controversial. The objective of this investigation was to gain more knowledge on the use of hand techniques for perineal support in Norwegian maternity wards.
  
  
  METHODS
  A questionnaire investigation addressed to the leaders of all the country''s maternity wards.
  
  
  RESULTS
  We received answers from 39 of 47 maternity wards (83 %) 34 of the wards said that most of those who helped at birth used hand support. 27 wards said that there had been a change in practice, and nearly all of them thought that the changes had taken place during the last five years. 17 wards had written guidelines on the use of hand support techniques. Without exception, use of the hand support technique was recommended. Almost half the wards recommended a modified Ritgen's manoeuvre ("the Finnish manoeuvre") In many wards the choice of perineal support was left to the individual birth helper.
  
  
  CONCLUSIONS
  Supporting techniques now seem to have become standard procedure in the great majority of Norwegian maternity wards. It is therefore difficult to carry out a comparative study between the use of hand manoeuvres and a passive approach. Further investigation should be carried out on whether the introduction of perineal support has had the desired effect.
authors.affiliation: Norwegian Knowledge Centre for Health Services and Institute of Health and Society, University of Oslo, Norway. atle.fretheim@kunnskapssenteret.no
authors.forename: Atle
authors.initials: A
authors.lastname: Fretheim
authors.forename: Tom
authors.initials: T
authors.lastname: Tanbo
authors.forename: Siri
authors.initials: S
authors.lastname: Vangen
authors.forename: Liv Merete
authors.initials: LM
authors.lastname: Reinar
authors.forename: John-Arne
authors.initials: JA
authors.lastname: Røttingen
mesh_terms: D001003:Anal Canal / Q000293:injuries*; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D009664:Norway; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D009775:Obstetrics and Gynecology Department, Hospital; D010502:Perineum; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D012421:Rupture; D011795:Surveys and Questionnaires