Better perineal outcomes in sitting birthing position cannot be explained by changing from upright to supine position for performing an episiotomy. (March 2016)

• Record Type: Journal Article
• Authors: Warmink-Perdijk, Willemijn D.B.; Koelewijn, Joke M.; de Jonge, Ank; van Diem, Mariet Th.; Lagro-Janssen, Antoine L.M.
• Is Part Of: Midwifery. Volume 34(2016)
• Page Start: 1
• Page End: 6
• Publication Date: 2016-03
• Subjects: Birthing positions -- Perineal damage -- Episiotomy -- Perineal tear; Midwifery -- Periodicals; Midwifery -- Periodicals; Sages-femmes -- Périodiques; Midwifery; Periodicals; Electronic journals; 618.2005
• DOI: 10.1016/j.midw.2016.01.010
• Languages: English
• ISSNs: 0266-6138

Abstract

Abstract: Background: women who give birth in supine position are more likely to have an episiotomy than women who give birth in sitting position. A confounding effect may be that women in upright positions in second stage of labour are asked to lie down if a professional needs to perform an episiotomy. This prospective cohort study aimed to determine whether this factor can explain the lower rate of episiotomy in sitting compared to supine position. Methods: data from 1196 women who had a spontaneous, vaginal birth were analysed. Positions during second stage and at birth were carefully recorded. Three groups of birthing positions were compared in multivariable analyses: 1) horizontal during second stage and supine at birth (horizontal/supine), 2) horizontal and upright during second stage and supine at birth (various/supine), 3) sitting at birth regardless of the position in second stage. Logistic regression analysis was used to adjust for known risk factors for perineal damage. Findings: women in sitting position at birth compared to those in the horizontal/supine group had a lower episiotomy rate (adjusted OR 0.28;95%-CI 0.14–0.56) and a non-significant higher intact perineum rate (adjusted OR 1.40, 95% CI 0.96–2.04). Women in the various/supine group compared to the horizontal/supine group had a similar episiotomy rate (adjusted OR 1.12;95%-CI 0.69–1.83). Conclusions: we did not confirm our hypothesis that more women in supine compared to sitting position have an episiotomy because women in upright position are asked to lie down if an episiotomy is necessary. Highlights: What is already known about this topic? Women who give birth in supine position are more likely to have an episiotomy than women who give birth in sitting position. It is unknown whether this may be explained by the fact that women in upright position are asked to lie down when an episiotomy is indicated. What does this article add? The episiotomy rate was similar among women who were in upright position during second stage, but supine at birth, and women who were in horizontal position during second stage and supine at birth. The lower rate of episiotomies in sitting birth position cannot be explained by a change from upright to supine position when an episiotomy is indicated.