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SPONTANEOUS PUSHING DURING BIRTH: Relationship To Perineal Outcomes


  • Carolyn M. Sampselle PhD, RNC, FAAN,

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    • Carolyn M. Sampselle is Professor of Nursing with joint appointments in medicine and women's studies at the University of Michigan. She is a certified women's health nurse practitioner.

  • Sandra Hines MS, RNC

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    • Sandra Hines is a graduate student at the University of Michigan. She is a certified women's health nurse practitioner and a research assistant at the University of Michigan.

Carolyn M. Sampselle, PhD, RNC, FAAN, University of Michigan, School of Nursing, Div. II, 400 North Ingalls, Ann Arbor, MI 48109–0482.


Vaginal birth is a recognized factor in perineal tissue damage and postpartum 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 pain had been in the perineal (or vaginal) area during the first week postpartum. 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 spontaneous pushing were more likely to have intact perineums postpartum and less likely to have episiotomies, and second or third degree lacerations (χ2 [3, N = 39] = 8.1, P = .043). Other variables, such as maternal age, infant birth weight, length of second stage, provider type, and use of epidural, did not demonstrate a significant difference in perineal outcome. Further analysis showed a significant relationship between the extent of perineal disruption and pain (F [3,30] = 5.08, P = .005).