Minimizing Genital Tract Trauma and Related Pain Following Spontaneous Vaginal Birth

Leah L. Albers, CNM, DrPH; Noelle Borders, CNM, MSN


J Midwifery Womens Health. 2007;52(3):246-253. 

In This Article

Sidebar: Key Concepts for Clinical Practice

  • Teach perineal massage with lubricant, for use by first-time mothers in the last 6 weeks of pregnancy.

  • Avoid Valsalva pushing in the second stage of labor unless a clear reason exists to expedite the delivery.

  • If an epidural is used, encourage a rest period of 1-2 hours after complete cervical dilatation prior to the commencement of any pushing.

  • Encourage upright or lateral positions for giving birth; help the woman identify and assume a position that is most comfortable for her at the time.

  • Use perineal management techniques (massage or compresses) only in selected situations, such as a mother's need for comfort or distraction.

  • Avoid episiotomy unless a compelling indication (such as severe fetal jeopardy) exists.

  • Control the expulsion of the baby at birth by using "hands on" with crowning and by delivering the baby's head slowly and between contractions.

  • Use the "Fleming method" of suturing. Leave the subcuticular layer unsutured if it is not gaping, and if it is, use a continuous stitch, keeping below the skin.

  • Use Dexon or Vicryl as the preferred suture materials for repair of any childbirth lacerations.

  • Prescribe oral ibuprofen for relief of perineal pain after birth in women with episiotomies or third- or fourth-degree lacerations.

  • Prescribe rectal ibuprofen for relief of perineal pain after birth in women who have episiotomies or second-degree perineal lacerations.

  • Encourage pelvic floor exercises and regular generalized exercise after childbirth.


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