Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears-An Experimental Study

Birth. 2017 Mar;44(1):86-94. doi: 10.1111/birt.12267. Epub 2016 Nov 14.


Introduction: Most women who give birth for the first time experience some form of perineal trauma. Second-degree tears contribute to long-term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second-degree tears among primiparous women.

Methods: An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro-iliac joints, and 3) a two-step head-to-body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables.

Results: A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second-degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33-0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention.

Conclusion: It is possible to reduce second-degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low- and high-risk pregnancies.

Keywords: birth position; midwifery intervention; second-degree tears; spontaneous pushing; two-step delivery.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anal Canal / injuries
  • Analgesia, Epidural / statistics & numerical data*
  • Episiotomy / adverse effects
  • Episiotomy / statistics & numerical data*
  • Female
  • Humans
  • Injury Severity Score
  • Midwifery / methods*
  • Midwifery / standards
  • Multivariate Analysis
  • Obstetric Labor Complications*
  • Parity
  • Perineum / injuries*
  • Perineum / surgery
  • Pregnancy
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Sweden
  • Young Adult