Spontaneous pushing during birth - Relationship to perineal outcomes

Vaginal birth is a recognized factor in perineal tissue damage and postpart um perineal pain. This study examined outcomes of 39 primiparous women who had spontaneous vaginal births. In a retrospective survey, women were asked to describe the type of pushing used to give birth and what the level of p ain had been in the perineal (or vaginal) area during the first week postpa rtum. Labor and delivery chart data documented extent of episiotomy and/or laceration sustained. Eleven (28%) women reported using spontaneous bearing down efforts, and the remaining 28 (72%) were directed. Women who used spo ntaneous pushing were more likely to have intact perineums postpartum and l ess likely to have episiotomies, and second or third degree lacerations chi (2) [3, N = 39] = 8.1, P = .043). Other variables, such as maternal age, in fant birth weight, length of second stage, provider type, and use of epidur al, did not demonstrate a significant difference in perineal outcome. Furth er analysis showed a significant relationship between the extent of perinea l disruption and pain (F [3,30] = 5.08, P = .005). (C) 1999 by the American College of Nurse-Midwives.