title: Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth.
abstract: Whether certain birth positions are associated with perineal injuries and severe perineal trauma (SPT) is still unclear. The objective of this study was to describe the prevalence of perineal injuries of different severity in a low-risk population of women who planned to give birth at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries.
  
  
  
  A population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data.
  
  
  
  Two thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included. The prevalence of SPT was 0.7 % and the prevalence of episiotomy was 1.0 %. There were differences between the countries regarding all maternal characteristics. No association between flexible sacrum positions and sutured perineal injuries was found (OR 1.02; 95 % CI 0.86-1.21) or SPT (OR 0.68; CI 95 % 0.26-1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10-0.54).
  
  
  
  A low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.
authors.affiliation: Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30, Gothenburg, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Edqvist
authors.affiliation: Research Group: Maternal, Reproductive and Children's Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway. ellen.blix@hioa.no.
authors.forename: Ellen
authors.identifier: 0000-0001-7971-4580
authors.initials: E
authors.lastname: Blix
authors.affiliation: Research Unit, Women's and Children's Health, Juliane Marie Center for Women, Children and Reproduction, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Hanne K
authors.initials: HK
authors.lastname: Hegaard
authors.affiliation: Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland.
authors.forename: Olöf Ásta
authors.initials: OÁ
authors.lastname: Ólafsdottir
authors.affiliation: Department of Nursing, Mid Sweden University, Sundsvall, Sweden.|Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Hildingsson
authors.affiliation: Homebirth Association Sealand, Copenhagen, Denmark.
authors.forename: Karen
authors.initials: K
authors.lastname: Ingversen
authors.affiliation: Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30, Gothenburg, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Mollberg
authors.affiliation: Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe hus 1, Box (PO) 457, 405 30, Gothenburg, Sweden.|Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Lindgren
mesh_terms: D000328:Adult; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008880:Midwifery; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D056888:Patient Positioning / Q000009:adverse effects*; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Birth positions; Episiotomy; Home birth; Perineal injuries; Severe perineal trauma; Waterbirth