Effect of Different Pushing Methods in the Second Stage of Labor on Perineal Injury

Document Type : Original Article

Authors

1 M.Sc. of Midwifery, Faculty of Nursing & Midwifery, North Kkhorasan University of Medical Sciences, Bojnord, Iran

2 M.Sc. of Midwifery, Faculty of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

3 M.Sc. in Midwifery, Faculty of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

4 Associate Professor of Public Health & Epidemiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: Despite the questions about the effectiveness of active pushing method in the second phase of delivery, this method is still being used in many centers. Researchers have shown that spontaneous pushing method decreases the perineal injuries. However such studies have not yet been done on Iranian women. We studied the effect of pushing method in the second stage of labor on perineal injury in a group of Iranian primiparous women.
 
Methods and Material: Randomized clinical trial of 108 primiparous women with uncomplicated labor a base fliess table randomly assigned to spontaneous and active groups. In spontaneous group used her own urge to push and active groups encouraged to take a deep breath, hold it and push for ten numbers. After delivery evaluation of perineal condition
 
Results: Episiotomy incidence lower in the spontaneous group (p< 0/021). Length and deep of pisiotomy lower in the spontaneous pushing versus active pushing (length p < 0/01 & deep p< 0/001). Perineal lacerations were no significant between groups.
 
Conclusion: Spontaneous pushing leads to lower rate of episiotomy. It is also an effective method that is accompanied by lower maternal complications after delivery.

Keywords

References

1. Willson RJ. Obstetrics and gynecology.8 th ed. Philadelphia:Mosby; 2004: 214.
2. Huestan WJ. Factores associated with the use of Episitomy during vaginal delivery. J
Obstet Gynecol 1996;87(6):1001-5.
3. Flynn P, Franick J, Janssen P, Hannah EY, Klein MC.How can second stage management
prevent perineal traum a critical review. Can Fam Physician 1997;43:73-84.
4. Robert JE. The push for Evidance: management of the second stage. J Midwifery
Women's Health 2002;47(1):2-15.
5. Hansen SL, Clark SL, Foster JC. Active pushging versus passive fetal descent in the
second stage of labeor,randomized controlled trial. Obstet Gynecol 2002;99(1):29-34.
6. Varney H. Varnay's Mid wifery. 3rd
ed. Boston,Jones and Bartlett 2004:446-54.
7. Mahler DA, Frocelicher VF, Houston- miller N, Yourk TD. ACSM's guid lines for
exercise testing and prescription. 5th ed. Philadelphia: Williams& Wilkins;1995.
8. Vujnovich AL, Dawson NJ. The effect of therapeutic muscle stretch on neural
processing. J Orthop Sport PhysTther 1994;20:145-53.
9. Sampselle CM, Hiness. Spontaneous pushing during birth relationship to perineal
outcome. J Nurs Midwifery 1999;4(1):36-9
10. Handa VL, Hariss TA. Protecting the pelvic floor obstetvic management to prevent
incotinence and pelvic organ prolapse. Obstet Gynecol 1996;88:470-8 
 
11. Beynon C. The normal second stage of labor: aplea for reform in it's conduc. J Obstet
Gyeacol Br Commonhealth 1957:64:815-20
12. Fraser WD, Marcoux S, Krauss I, Douglas J, Goulet C,Boulvain M. Multicenter,
randomized, controlled trial of delayed pushing for nulliparous women in the second
stage of labor with continous epidural analgesia. The PEOPLE (Pushing Early or
Pushing Late with Epidural) Study Group. Am J Obstet Gynecol 2000
May;182(5):1165-72.
13. Vause S, Congdon HM, Thornton JG. Immediate and delayed pushing in the second
stage of labour for nulliparous women with epidural analgesia: a randomized controlled
trail. Br J Obstet Gynecol 1998 Feb;105(2):186-8.
14. Parnell C, Langhoff-Roos J, Iversen R, Damgaard P. Pushing method in the expulsive
phase of labor. A randomized trial. Acta Obstet Gynecol Scand 1993 jan;72(1):31-5. 

Files

Share

How to cite

Statistics