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

Int Urogynecol J. 2012 Sep;23(9):1249-56. doi: 10.1007/s00192-012-1675-5. Epub 2012 Feb 2.


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) (n = 96) or AMB (n = 103). 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 (OR = 4.49; p< 0.05), which, in turn, was significantly associated with nulliparity (OR = 5.52; p<0.005) and fetal head unengaged at full dilatation (OR = 5.35; 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 the passive expulsive phase of labor and lateral position during active pushing time is associated with reductions in AVD and PT.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesia, Epidural
  • Episiotomy / statistics & numerical data
  • Extraction, Obstetrical / statistics & numerical data
  • Female
  • Humans
  • Labor Presentation
  • Labor Stage, Second
  • Lacerations / prevention & control*
  • Logistic Models
  • Multivariate Analysis
  • Muscle Contraction
  • Odds Ratio
  • Parity
  • Parturition*
  • Patient Positioning*
  • Perineum / injuries*
  • Pregnancy