Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre

Authors

  • Flora MB da Silva,

    1. Authors:Flora MB da Silva, PhD, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo; Sonia MJV de Oliveira, PhD, Nurse Midwife, School of Nursing, University of São Paulo, São Paulo, Brazil; Debra Bick, MMedSc, PhD, Registered Midwife, King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK; Ruth H Osava, PhD, Nurse Midwife, School of Arts, Sciences and Humanities – EACH, University of São Paulo, São Paulo; Esteban F Tuesta, PhD, Statistician, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo; Maria LG Riesco, PhD, Nurse Midwife and Associate Professor, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
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  • Sonia MJV de Oliveira,

    1. Authors:Flora MB da Silva, PhD, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo; Sonia MJV de Oliveira, PhD, Nurse Midwife, School of Nursing, University of São Paulo, São Paulo, Brazil; Debra Bick, MMedSc, PhD, Registered Midwife, King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK; Ruth H Osava, PhD, Nurse Midwife, School of Arts, Sciences and Humanities – EACH, University of São Paulo, São Paulo; Esteban F Tuesta, PhD, Statistician, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo; Maria LG Riesco, PhD, Nurse Midwife and Associate Professor, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
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  • Debra Bick,

    1. Authors:Flora MB da Silva, PhD, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo; Sonia MJV de Oliveira, PhD, Nurse Midwife, School of Nursing, University of São Paulo, São Paulo, Brazil; Debra Bick, MMedSc, PhD, Registered Midwife, King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK; Ruth H Osava, PhD, Nurse Midwife, School of Arts, Sciences and Humanities – EACH, University of São Paulo, São Paulo; Esteban F Tuesta, PhD, Statistician, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo; Maria LG Riesco, PhD, Nurse Midwife and Associate Professor, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
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  • Ruth H Osava,

    1. Authors:Flora MB da Silva, PhD, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo; Sonia MJV de Oliveira, PhD, Nurse Midwife, School of Nursing, University of São Paulo, São Paulo, Brazil; Debra Bick, MMedSc, PhD, Registered Midwife, King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK; Ruth H Osava, PhD, Nurse Midwife, School of Arts, Sciences and Humanities – EACH, University of São Paulo, São Paulo; Esteban F Tuesta, PhD, Statistician, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo; Maria LG Riesco, PhD, Nurse Midwife and Associate Professor, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
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  • Esteban F Tuesta,

    1. Authors:Flora MB da Silva, PhD, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo; Sonia MJV de Oliveira, PhD, Nurse Midwife, School of Nursing, University of São Paulo, São Paulo, Brazil; Debra Bick, MMedSc, PhD, Registered Midwife, King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK; Ruth H Osava, PhD, Nurse Midwife, School of Arts, Sciences and Humanities – EACH, University of São Paulo, São Paulo; Esteban F Tuesta, PhD, Statistician, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo; Maria LG Riesco, PhD, Nurse Midwife and Associate Professor, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
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  • Maria LG Riesco

    1. Authors:Flora MB da Silva, PhD, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo; Sonia MJV de Oliveira, PhD, Nurse Midwife, School of Nursing, University of São Paulo, São Paulo, Brazil; Debra Bick, MMedSc, PhD, Registered Midwife, King’s College London, Florence Nightingale School of Nursing and Midwifery, London, UK; Ruth H Osava, PhD, Nurse Midwife, School of Arts, Sciences and Humanities – EACH, University of São Paulo, São Paulo; Esteban F Tuesta, PhD, Statistician, School of Arts, Sciences and Humanities, University of São Paulo, São Paulo; Maria LG Riesco, PhD, Nurse Midwife and Associate Professor, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
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Flora MB da Silva, Nurse Midwife, National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar, 419, CEP 05403-000 São Paulo, Brazil. Telephone: +55 11 3061 7602.
E-mail:floramaria@usp.br

Abstract

Aim and objectives.  To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre.

Background.  Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy.

Design.  Cross-sectional study.

Methods.  Data were retrospectively collected from one independent birth centre in Brazil, during 2006–2009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median).

Results.  There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only.

Conclusions.  Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies.

Relevance to clinical practice.  The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

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