Striving for scientific stringency: a re-analysis of a randomised controlled trial considering first-time mothers’ obstetric outcomes in relation to birth position

Abstract

BackgroundThe aim of this study was to compare maternal labour and birth outcomes between women who gave birth on a birth seat or in any other position for vaginal birth and further, to study the relationship between synthetic oxytocin augmentation and maternal blood loss, in a stratified sample.MethodsA re-analysis of a randomized controlled trial in Sweden. An on-treatment analysis was used to study obstetrical outcomes for nulliparous women who gave birth on a birth seat (birth seat group) compared to birth in any other position for vaginal birth (control group). Data were collected between November 2006 and July 2009. The outcome measurements included perineal outcome, post partum blood loss, epidural analgesia, synthetic oxytocin augmentation and duration of labour.ResultsThe major findings of this paper were that women giving birth on the birth seat had shorter duration of labour and were significantly less likely to receive synthetic oxytocin for augmentation in the second stage of labour. Significantly more women had an increased blood loss when giving birth on the birth seat, but had no difference in perineal outcomes. Blood loss was increased regardless of birth position if women had been exposed to synthetic oxytocin augmentation during the first stage of labour.ConclusionsThe results of this analysis imply that women with a straightforward birth process may well benefit from giving birth on a birth seat without risk for any adverse obstetrical outcomes. However it is important to bear in mind that, women who received synthetic oxytocin during the first stage of labour may have an increased risk for greater blood loss when giving birth on a birth seat. Finally it is of vital importance to scrutinize the influence of synthetic oxytocin administered during the first stage of labour on blood loss postpartum, since excessive blood loss is a well-documented cause of maternal mortality worldwide and may cause severe maternal morbidity in high-income countries.Trial registrationUnique Protocol ID: NCT01182038 ( http://register.clinicaltrials.gov)

Análise dos desfechos do uso da banqueta durante o trabalho de parto: revisão sistemática

“…Os quatro estudos selecionados para esta revisão abordaram os temas relacionados a diferentes posições de parto abordando tempo de duração do trabalho de parto (especialmente durante o segundo estágio) [14,27], possibilidade de lesões obstétricas (lacerações) [22,24,25], uso de instrumentação no parto (fórceps, vácuo) [25,27],…”

“…episiotomia [22,24,25], uso de analgesia [14,27], encaminhamento para parto cesáreo [22,25], perda de sangue [24,25] e edema [24,25]. Apenas um dos trabalhos avaliou a dor nas quatro fases do trabalho de parto [23].…”

“…Apenas um dos trabalhos avaliou a dor nas quatro fases do trabalho de parto [23]. Desses estudos, dois foram realizados na Suécia [24,25], um no Irã [23] e um no Reino Unido [22].…”

“…Em termos metodológicos, de acordo com a escala PEDro, um único estudo Nesta pesquisa, o desfecho mais estudado foi o risco de lesões obstétricas com o uso de fórceps ou vácuo, descrito em quatro graus de laceração perineal. Destes, três [22,24,25] abordaram este tema e em nenhum dos grupos houve diferença significativa entre as posições de parto. Sabe-se que a lesão do esfíncter anal externo (EAE) tratase do 4º grau de laceração e, quando comprometido, pode levar a eventos de incontinência urinária e fecal, disfunção sexual, dor e redução da qualidade de vida, bem como diminuição da força muscular do assoalho pélvico e prolapso dos órgãos pélvicos [27][28][29].…”

Effect of Flexible Sacrum Position on Maternal and Neonatal Outcomes in Public Health Facilities, Amhara Regional State, Ethiopia: A Quasi-Experimental Study

“…Women instinctively use standing, walking, rhythmic swaying movements, and positions in response to pain or other sensations during labor (1). It is well known that throughout the ages and across human cultures, women giving birth alone have preferred to do this with their bodies vertical in sitting or squatting positions by grasping a tree, ropes or knotted piece of cloth and generally avoiding lying flat on their back [ 14 , 17 , 18 , 19 , 20 ].…”