Perineal injury associated with hands on/hands poised and directed/undirected pushing: A retrospective cross-sectional study of non-operative vaginal births, 2011–2016

Abstract

BackgroundClinicians hand position and advised pushing techniques may impact on rates of perineal injury. ObjectiveTo assess the association of four techniques used in management of second stage with risk of moderate and severe perineal injury. DesignRetrospective cross-sectional study. SettingA metropolitan maternity hospital and a private maternity hospital in Brisbane, Australia. ParticipantsTerm women with singleton, cephalic presentation experiencing a non-operative vaginal birth from January 2011 to December 2016. MethodsThe research sites perinatal database recorded data on clinicians approach to instructing women during second stage and hand position at birth. Women were identified from matching the inclusion criteria (n = 26,393) then grouped based on combinations of hands-on, hand- poised, directed and undirected pushing. The associations with perineal injury were estimated using odds ratios obtained by multivariate analysis. Primary outcomes were the risk of moderate and severe perineal injury. The significance was set at 0.001. ResultsIn Nulliparous women there was no difference in the risk of moderate or severe perineal injury between the different techniques. In multiparous women the use of a hands-on/directed approach was associated with a significant increase in the risk of moderate (AOR 1.18, 95% CI 1.10–1.27, p < 0.001) and severe perineal injury (AOR 1.50, 95% CI 1.20–1.88, p < 0.001) compared to hands-poised/undirected. ConclusionsA hands poised/undirected approach could be utilised in strategies for the prevention of moderate and severe perineal injury.