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Getting Through Birth in One Piece: Protecting the Perineum

Hastings-Tolsma, Marie PhD, CNM; Vincent, Deborah PhD, RN, FAANP; Emeis, Cathy MS, CNM; Francisco, Teresa MS, RN

MCN, The American Journal of Maternal/Child Nursing: May-June 2007 - Volume 32 - Issue 3 - p 158–164
doi: 10.1097/01.NMC.0000269565.20111.92
feature article

Purpose To identify factors related to perineal trauma in childbirth, replicating the work of Albers et al. (1996).

Study Design and Method A retrospective descriptive analysis of pregnancy and birth data recorded into the Nurse Midwifery Clinical Data Set for women (N = 510) with a singleton pregnancy and largely uncomplicated prenatal course. Prenatal care occurred at four prenatal clinics with births at a tertiary care facility during 1996–1997, with care provided by nurse midwifery faculty. Multivariate statistics detailed clinical characteristics associated with perineal trauma.

Results Episiotomy was related to parity, marital status, infant weight, fetal bradycardia, prolonged second stage labor, and lack of perineal care measures. Factors related to laceration were age, insurance status, and marital status. For all women, laceration was more likely when in lithotomy position for birth (p = .002) or when prolonged second stage labor occurred (p = .001). Factors that were protective against perineal trauma included massage, warm compress use, manual support, and birthing in the lateral position. Albers et al. (1996) found that ethnicity and education were related to episiotomy and that warm compresses were protective. In this study, use of oils/lubricants increased lacerations, as did lithotomy positioning. Laceration rates were similar in both studies. Episiotomy use was lower in this study.

Clinical Implications Side-lying position for birth and perineal support and compress use are important interventions for decreasing perineal trauma. Strategies to promote perineal integrity need to be implemented by nurses who provide prenatal education and care for the laboring woman.

Are there things that nurses can do to help prevent episiotomy or perineal laceration? This research suggests there are.

Marie Hastings-Tolsma is an Associate Professor, Nurse Midwifery, University of Colorado at Denver & Health Sciences Center. She can be reached via e-mail at

Deborah Vincent is an Associate Professor, College of Nursing, University of Arizona, Tucson.

Cathy Emeis is an Instructor of Nursing, University of Colorado—Colorado Springs.

Teresa Francisco is the Director, Women and Children's Center, Vail Valley Medical Center, Vail, CO.

The authors have no conflict of interest.

© 2007 Lippincott Williams & Wilkins, Inc.