Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births

doi:10.1111/j.0730-7659.2006.00085.x

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Wiley InterScience

Birth

Volume 33 Issue 2, Pages 94 - 100

Published Online: 24 May 2006

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Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births

Leah L. Albers, CNM, DrPH ¹ *, Kay D. Sedler, CNM, MN ¹ , Edward J. Bedrick, PhD ¹ , Dusty Teaf, MA ¹ , and Patricia Peralta ¹

¹ Leah Albers is Professor in the College of Nursing, and in the Department of Obstetrics & Gynecology, School of Medicine, University of New Mexico Health Sciences Center; Kay Sedler was Director of the Nurse‐Midwifery Division, Department of Obstetrics & Gynecology, University of New Mexico Health Sciences Center; Ed Bedrick is Professor of Mathematics and Statistics, University of New Mexico; Dusty Teaf is a Senior Technical Support Analyst, Computer Information, Resources, and Technology Center, University of New Mexico; and Patricia Peralta is a Research Administrator, College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.

Correspondence to * Leah L. Albers, CNM, DrPH, FACNM, FAAN, University of New Mexico College of Nursing, Nursing/Pharmacy Bldg, Rm 216, Albuquerque, NM 87131‐5688, USA.

This work was supported by grant 1 R01 NR05252‐01A1 from the National Institutes of Health/National Institute of Nursing Research (PI, Albers), Bethesda, Maryland, USA.

ABSTRACT

Abstract: Objective: Episiotomy rates are declining in the United States. In settings with very low rates, evidence remains sparse on how best to facilitate birth without lacerations. The purpose of this investigation was to identify maternal and clinical factors related to genital tract trauma in normal, spontaneous vaginal births. Methods:Data from a randomized clinical trial of perineal management techniques were used to address the study objective. Healthy women had spontaneous births with certified nurse‐midwives in a medical center setting. Proportions of maternal characteristics and intrapartum variables were compared in women who did and did not sustain sufficient trauma to warrant suturing, according to parity (first vaginal births versus others). Logistic regression using a backward elimination strategy was used to identify predictors of obstetric trauma. Results: In women who had a first vaginal birth, risk factors for trauma were maternal education of high school or beyond, Valsalva pushing, and infant birthweight. Risk factors in women having a second or higher vaginal birth were prior sutured trauma and infant birthweight. For all mothers, delivery of the infant's head between contractions was associated with reduced trauma to the genital tract. Conclusions:Delivery technique that is unrushed and controlled may help reduce obstetric trauma in normal, spontaneous vaginal births. (BIRTH 33:2 June 2006)

Received: 28 February 2002; Accepted: 09 September 2002;

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.0730-7659.2006.00085.x About DOI