Risk of Perineal Damage is Not a Reason to Discourage a Sitting Birthing Position: A Secondary Analysis

A. De Jonge; M. Th. Van Diem; P. L. H. Scheepers; S. E. Buitendijk; A.L.M. Lagro-Janssen

Disclosures

Int J Clin Pract. 2010;65(5):611-618. 

In This Article

Results

Most of the 1646 women in the study gave birth in recumbent position followed by semi-sitting and sitting position (Table 1). Women in sitting position were more likely to be older (over 30 years) than women in other positions. In recumbent position fewer women were primiparous than in other positions, but this difference was not significant. The duration of the second stage was most likely to be up to 10 min in women who were in recumbent position at the time of birth, between 11 and 60 min in women in semi-sitting position and more than 60 min in women in sitting position. There were no differences in ethnic background and birthweight over 3500 g between the position groups.

Figure 1 shows the occurrence of perineal damage in the position groups in percentages. Many women had more than one type of perineal damage. In the total group, 720 (43.8%) women had a first or second degree tear. This was the most common type of perineal damage. An episiotomy was performed in 375 (22.8%) women. Of these episiotomies, 15 were median and 360 were mediolateral (data not shown). A third degree tear occurred in 31 (1.9%) women. A total of 18 women in recumbent position (2.0%), 9 (1.5%) in semi-sitting position and 4 (3.4%) in sitting position had a third degree tear. These differences were not significant (p = 0.378). Three third degree tears occurred in women with a mediolateral episiotomy, who were all in recumbent position. None occurred in women with a median episiotomy. A labial tear occurred in 153 (9.3%) women.

Figure 1.

Perineal damage

Table 2 shows the associations between various factors and perineal outcome.

There were no significant differences in the intact perineum rate between the position groups. Women in sitting position had fewer episiotomies and more second degree perineal tears than women in recumbent or semi-sitting position. Women in semi-sitting position had more labial tears than women in other positions. Women aged 25 years or younger and 36 years or older were more likely to have an intact perineum than women between 26 and 35 years. They had a non-significant tendency to fewer episiotomies. There were fewer labial tears with increasing age.

No significant differences were found in perineal damage between women of Dutch and non-Dutch ethnic background.

Primiparous women had more episiotomies and more labial tears, whereas multiparous women had more perineal tears but also more often an intact perineum.

A longer duration of the second stage was associated with more episiotomies, fewer perineal tears and fewer intact perinea. Women with a second stage between 11 and 60 min were more likely to have a labial tear than women with a second stage up to 10 min and those with a second stage over 60 min.

Birthweight over 3500 g was associated with more perineal tears and fewer intact perinea. The association between birthweight over 3500 g and more episiotomies was borderline significant.

We conducted a logistic regression analysis to study the net effects of various factors on perineal outcome (Table 3).

No significant differences were found in intact perineum between the position groups. Women in sitting position were less likely to have an episiotomy and more likely to have a perineal tear than women in other positions. Women in semi-sitting position were more likely to have a labial tear.

Age 25 years and below was associated with a higher rate of intact perineum than age between 26 and 35 years. Women between 31 and 35 years were also more likely to have an episiotomy than women of 25 years or younger.

Primiparous women had more episiotomies, more labial tears and less often an intact perineum than multiparous women.

Women with a second stage longer than 10 min had more episiotomies and less often an intact perineum than women with a second stage of 10 min or below. A second stage between 11 and 60 min was associated with more labial tears and over 60 min with fewer perineal tears.

Birthweight over 3500 g was associated with more episiotomies, more perineal tears and fewer intact perinea.

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