Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma

Introduction and hypothesis: This study was conducted to evaluate the effects of an alternative model of birth (AMB) on the incidence of assisted vaginal delivery (AVD) and perineal trauma (PT). Methods One hundred ninety-nine women with epidural anesthesia were randomized to a traditional model of birth (TMB) (n096) or AMB (n0103). Women in TMB pushed immediately after complete dilatation and delivered in lithotomy position. In AMB, women followed a postural changes protocol while they delayed pushing and used a specific lateral position for delivery.

Results: AMB was associated with a significant reduction in AVD compared with TMB (19.8% vs 42.1%, p<0.001). TMB was strongly associated with AVD (OR04.49; p<0.05), which, in turn, was significantly associated with nulliparity (OR05.52; p<0.005) and fetal head unengaged at full dilatation (OR05.35; p<0.05). AMB significantly increased the intact perineum rate compared with TMB (40.3% vs 12.2%, p<0.001). Episiotomy rate was significantly reduced in AMB (21.0% vs 51.4%, p<0.001).

Conclusion: A combination of postural changes during thepassive expulsive phase of labor and lateral position during active pushing time is associated with reductions in AVD and PT.