Perineal outcomes in a home birth setting

Background: Perineal lacerations are a source of significant discomfort to many women. This descriptive study examined perineal outcomes in a home bir th population, and provides a preliminary description of factors associated with perineal laceration and episiotomy. Methods: Data were drawn from a p rospective cohort study of 1404 intended home births in nurse-midwifery pra ctices. Analyses focused on a subgroup of 1068 women in 28 midwifery practi ces who delivered at home with a midwife in attendance. Perineal trauma inc luded both episiotomy and lacerations. Minor abrasions and superficial lace rations that did not require suturing were included with the intact perineu m group. Associations between perineal trauma and study variables were exam ined in the pooled dataset and for multiparous and nulliparous women separa tely. Results: lit this sample 69.6 percent of the women had an intact peri neum, 15 (1.4%) had an episiotomy, 28.9 percent had first- or second-degree lacerations, and 7 women (0.7%) had third- or fourth-degree lacerations. L ogistic regression analyses showed that in multiparas, low socioeconomic st atus and higher parity were associated with intact perineum, whereas older age (greater than or equal to 40 yr), previous episiotomy, weight gain of o ver 40 pounds, prolonged second stage, and the use of oils or lubricants we re associated with perineal trauma. Among nulliparas, low socioeconomic sta tus, kneeling or hands-and-knees position at delivery, and manual support o f the perineum at delivery were associated with intact perineum, whereas pe rineal massage during delivery was associated with perineal trauma. Conclus ions: The results of this study suggest that it is possible for midwives to achieve a high rate of intact perineums and a low rate of episiotomy in a select setting and with a select population.