Two Midwives Better Than One During Second Stage of Labor

By Reuters Staff

March 28, 2022

NEW YORK (Reuters Health) - Severe perineal tears happen less often when two midwives are present during the second stage of labor, according to a large Swedish study of first-time mothers.

"Severe perineal trauma affecting the anal sphincter muscle complex is a serious complication following childbirth, associated with short-term and long-term maternal morbidity. Effective preventive strategies are still scarce," researchers note in The Lancet.

The Oneplus trial tested the impact of having a second midwife present during the second stage of labor for the purpose of preventing severe perineal trauma.

During delivery, 3,750 women were randomly assigned to get support and care from either one or two midwives; 1,546 women who gave birth with two midwives and 1,513 who gave birth with one midwife were included in intention-to-treat analysis.

The results showed a significant reduction in severe perineal trauma with two midwives present (3.9% vs. 5.7%; adjusted odds ratio, 0.69; 95% CI, 0.49 to 0.97).

"Although severe perineal tears are rare, they can lead to significant and sometimes lifelong consequences for the women," Dr. Christine Rubertsson, professor at Lund University, midwife at Skaane University Hospital and principal investigator for the study, says in a news release.

"Many maternity units have already adopted this clinical practice of collegial assistance with two midwives, and this study provides evidence for the reduction in severe in perineal trauma," adds Dr. Malin Edqvist, midwife at the Karolinska University Hospital and researcher at Karolinska Institute, in Stockholm, who led the study during her time as a postdoc at Lund University.

The authors of a linked editorial say, "Considering that the effective intervention required little to no extra resources, the results were particularly welcome because the intervention could potentially be implemented in other obstetric units without the need for more funding."

"The decision making process concerning how to prevent obstetric anal sphincter injury consists of several interacting components and depends on midwives' skills and experiences, reflecting the context of real-life clinical practice," write Dr. Rebecka Dalbye of Oslo Metropolitan University and Dr. Hege Holmo Johannessen of Østfold University College, in Halden, Norway.

Confirming the Oneplus findings, a series on midwifery care published in The Lancet showed that "outcomes are enhanced when educated and licensed midwives lead care as part of interdisciplinary teams that are integrated with the health system," they note.

SOURCE: and The Lancet, online March 15, 2022.