Presence of two midwives can reduce severe perineal trauma in first time vaginal births
Having two midwives present during the active second stage of labor may reduce the risk of severe perineal trauma in women giving birth vaginally for the first time, according to a study published in The Lancet.
“Most high-income countries have seen an increase in severe perineal trauma during the past years,” Malin Edqvist, RNM, PhD, university midwife in the department of women’s health and health professions at the Karolinska University Hospital in Sweden, told Healio. “In Scandinavia, prevention of severe perineal trauma has been very much debated among all professions involved, as these injuries are known to have both short- and long-term consequences for women. Midwives feel both guilt and shame if a woman sustains severe perineal trauma during birth, and seek to find new ways of preventing injuries.
“In recent years, many obstetric units in Sweden have adopted a new clinical practice with collegial midwifery assistance during the second stage and the birth of the baby, with the aim of preventing severe perineal trauma,” Edqvist continued. “We wanted to evaluate if this practice was effective or if it had other unforeseen effects.”
Edqvist and colleagues enrolled 3,059 women, aged 18 to 47 years, from five obstetric units in Sweden in a multicenter, randomized controlled trial. The study included women carrying a singleton pregnancy, planning a first-time vaginal birth and at 37 weeks’ gestation or later. Participants were randomly assigned to an intervention group (n = 1,546; mean age, 29.4 years) that received assistance from two midwives in the second stage of labor or a standard care control group (n = 1,513; mean age, 29.5 years) that received assistance from one midwife. Primary midwives were instructed to follow existing prevention models, and second midwives were instructed to assist the primary midwives if asked.
“It was interesting to see the variety of support the second midwives provided and that the focus was related to communication and support,” Edqvist said. “The assistance was much more about providing two sets of eyes to evaluate the situation and help the woman to achieve a slow and controlled birth of the baby, rather than focusing only on manual perineal protection.”
Researchers found a significant reduction in SPT in the intervention group compared with the control group (3.9% vs. 5.7%, respectively; adjusted OR = 0.69; 95% CI, 0.49-0.97). No statistically significant differences were observed between groups for maternal and neonatal outcomes.
“Collegial midwifery assistance reduces severe perineal trauma for women who give birth vaginally for the first time,” Edqvist said. “We suggest that the intervention could be translated to other settings where two midwives are already standard care, if the aim of the second midwife’s presence is altered to include prevention of severe perineal trauma.”