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Perineal Injury in Nulliparous Women Giving Birth at a Community Hospital: Reduced Risk in Births Attended by Certified Nurse-Midwives

Authors

  • Maureen Browne RM (UK), RN, MPH,

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    • Maureen Browne, RM (UK), RN, MPH, conducted this research as part of a master's in Public Health in Maternal and Child Health at the University of California, Berkeley, Berkeley, CA. Currently employed as Lead Coordinator for the CA State Newborn Screening Program at Kaiser Permanente Northern California, she is also a Registered Midwife in the United Kingdom and Australia.

  • Mark Jacobs MD,

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    • Mark Jacobs, MD, FACOG, is the Medical Director of Women's Health Services, Marin County Department of Health and Social Services, as well as Perinatologist at Marin General Hospital, Greenbrae, CA. He is a Clinical Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences, at the University of California, San Francisco, San Francisco, CA.

  • Maureen Lahiff PhD,

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    • Maureen Lahiff, PhD, is Lecturer in Biostatistics in the School of Public Health, University of California, Berkeley, Berkeley, CA.

  • Suellen Miller CNM, RN, MHA, PhD

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    • Suellen Miller, CNM, RN, MHA, PhD, is Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, where she is also the Director of Safe Motherhood Programs. She is Associate Professor in the Maternal and Child Health Program, School of Public Health, at the University of California, Berkeley, Berkeley, CA.


Department of Genetics, Kaiser Permanente Northern California, 280 West MacArthur Blvd., Oakland, CA 94611. E-mail: maureenbb@gmail.com

Abstract

Introduction: Our objective was to determine if there is a difference in rates of perineal injury sustained by nulliparous women attended by obstetricians compared with certified nurse-midwives (CNMs) at a US community hospital.

Methods: We analyzed retrospective data for 2819 women who spontaneously gave birth to singleton, vertex, term, live infants between 2000 and 2005. The independent variable was attendant type (obstetrician or CNM). The main outcome variables were intact perineum, episiotomy, and spontaneous perineal lacerations. Multivariate logistic regression was used to adjust for six potential confounders: macrosomia, maternal age, epidural anesthesia, oxytocin administration, medical insurance status, and ethnicity.

Results: The odds ratios (ORs) for obstetrician-attended births versus CNM-attended births were significant for a spontaneous minor perineal laceration versus intact perineum (OR = 1.82; 95% confidence interval [CI], 1.33–2.48), spontaneous major laceration versus intact perineum (OR = 2.29; 95% CI, 1.13–4.66), and episiotomy use versus no perineal injury, with or without extension (OR = 2.94; 95% CI, 2.01–4.29).

Discussion: We found that the prevalence and severity of perineal injury, both spontaneous and from episiotomy use, were significantly lower in CNM-attended births.

J Midwifery Womens Health 2010;55:243–249 c̊ 2010 by the American College of Nurse-Midwives.

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