Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma.
OBJECTIVE
This study was conducted to evaluate the effects of an alternative model of birth (AMB) on the incidence of assisted vaginal delivery (AVD) and perineal trauma (PT).


METHODS
One hundred ninety-nine women with epidural anesthesia were randomized to a traditional model of birth (TMB) (n = 96) or AMB (n = 103). Women in TMB pushed immediately after complete dilatation and delivered in lithotomy position. In AMB, women followed a postural changes protocol while they delayed pushing and used a specific lateral position for delivery.


RESULTS
AMB was associated with a significant reduction in AVD compared with TMB (19.8% vs 42.1%, p<0.001). TMB was strongly associated with AVD (OR = 4.49; p< 0.05), which, in turn, was significantly associated with nulliparity (OR = 5.52; p<0.005) and fetal head unengaged at full dilatation (OR = 5.35; p<0.05). AMB significantly increased the intact perineum rate compared with TMB (40.3% vs 12.2%, p<0.001). Episiotomy rate was significantly reduced in AMB (21.0% vs 51.4%, p<0.001).


CONCLUSIONS
A combination of postural changes during the passive expulsive phase of labor and lateral position during active pushing time is associated with reductions in AVD and PT.
Department of Physiotherapy, European University of Madrid, c/ Villaviciosa de Odón s/n, 28260 Madrid, Spain. carolina.gestos@gmail.com
Carolina
C
Walker
Tania
T
Rodríguez
Ana
A
Herranz
José A
JA
Espinosa
Emília
E
Sánchez
Montserrat
M
Espuña-Pons
D000328:Adult; D015360:Analgesia, Epidural; D004841:Episiotomy / Q000706:statistics & numerical data; D005113:Extraction, Obstetrical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007746:Labor Presentation; D007748:Labor Stage, Second; D022125:Lacerations / Q000517:prevention & control*; D016015:Logistic Models; D015999:Multivariate Analysis; D009119:Muscle Contraction; D016017:Odds Ratio; D010298:Parity; D036801:Parturition; D056888:Patient Positioning; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy