No reducation in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial
Författare
Summary, in English
Abstract
Background: The WHO advises against recumbent or supine position for longer periods during labour and birth
and states that caregivers should encourage and support the woman to take the position in which she feels most
comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk
for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this
study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during
the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births
and may thus counterbalance any increase in perineal trauma and blood loss.
Methods: A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat
(experimental group) or birth in any other position (control group). Data were collected between November 2006
and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome
measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by
intention to treat.
Results: The main findings of this study were that birth on the birth seat did not reduce the number of
instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave
birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal
edema.
Conclusions: The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an
increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a
birth seat caused no adverse consequences for perineal outcomes and may even be protective against
episiotomies.
Trial registration number: ClinicalTrials.gov.ID: NCT01182038
Background: The WHO advises against recumbent or supine position for longer periods during labour and birth
and states that caregivers should encourage and support the woman to take the position in which she feels most
comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk
for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this
study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during
the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births
and may thus counterbalance any increase in perineal trauma and blood loss.
Methods: A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat
(experimental group) or birth in any other position (control group). Data were collected between November 2006
and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome
measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by
intention to treat.
Results: The main findings of this study were that birth on the birth seat did not reduce the number of
instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave
birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal
edema.
Conclusions: The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an
increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a
birth seat caused no adverse consequences for perineal outcomes and may even be protective against
episiotomies.
Trial registration number: ClinicalTrials.gov.ID: NCT01182038
Publiceringsår
2011
Språk
Engelska
Publikation/Tidskrift/Serie
BMC Pregnancy and Childbirth
Volym
11
Issue
22
Fulltext
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Länkar
Dokumenttyp
Artikel i tidskrift
Förlag
BioMed Central (BMC)
Ämne
- Medical and Health Sciences
Nyckelord
- birth* seat
- childbirth
- instrumental delivery
- upright position
Status
Published
Forskningsgrupp
- Child and Family Health
ISBN/ISSN/Övrigt
- ISSN: 1471-2393