Clinical Question:

To mothers following normal childbirth, is episiotomy increases the risk for perineal trauma
than spontaneous laceration?

Citation:
1. Tolsma M et al,. Getting through births in One Piece Protecting the Perineum. American
Journal of Maternal Child Nursing. May- June 2007

2. Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births Albers et al.

Conclusion:
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. 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

Recommendation:
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.
Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births
Leah L. Albers, CNM, DrPH 1 *, Kay D. Sedler, CNM, MN 1 , Edward J. Bedrick, PhD 1 , Dusty Teaf,
MA 1 , and Patricia Peralta 1
1 Leah Albers is Professor in the College of Nursing, and in the Department of Obstetrics &
Gynecology, School of Medicine, University of New Mexico Health Sciences Center; Kay Sedler was
Director of the Nurse‐Midwifery Division, Department of Obstetrics & Gynecology, University of New
Mexico Health Sciences Center; Ed Bedrick is Professor of Mathematics and Statistics, University of
New Mexico; Dusty Teaf is a Senior Technical Support Analyst, Computer Information, Resources, and
Technology Center, University of New Mexico; and Patricia Peralta is a Research Administrator,
College of Nursing, University of New Mexico Health Sciences Center, Albuquerque, New Mexico,
USA.
Correspondence to * Leah L. Albers, CNM, DrPH, FACNM, FAAN, University of New Mexico
College of Nursing, Nursing/Pharmacy Bldg, Rm 216, Albuquerque, NM 87131‐5688, USA.

This work was supported by grant 1 R01 NR05252‐01A1 from the National Institutes of
Health/National Institute of Nursing Research (PI, Albers), Bethesda, Maryland, USA.
Copyright Blackwell Publishing, Inc. 2006

ABSTRACT
Abstract: Objective: Episiotomy rates are declining in the United States. In settings with very low
rates, evidence remains sparse on how best to facilitate birth without lacerations. The purpose of this
investigation was to identify maternal and clinical factors related to genital tract trauma in normal,
spontaneous vaginal births. Methods:Data from a randomized clinical trial of perineal management
techniques were used to address the study objective. Healthy women had spontaneous births with
certified nurse‐midwives in a medical center setting. Proportions of maternal characteristics and
intrapartum variables were compared in women who did and did not sustain sufficient trauma to
warrant suturing, according to parity (first vaginal births versus others). Logistic regression using a
backward elimination strategy was used to identify predictors of obstetric trauma. Results: In women
who had a first vaginal birth, risk factors for trauma were maternal education of high school or beyond,
Valsalva pushing, and infant birthweight. Risk factors in women having a second or higher vaginal
birth were prior sutured trauma and infant birthweight. For all mothers, delivery of the infant's head
between contractions was associated with reduced trauma to the genital tract. Conclusions:Delivery
technique that is unrushed and controlled may help reduce obstetric trauma in normal, spontaneous
vaginal births. (BIRTH 33:2 June 2006)

Received: 28 February 2002; Accepted: 09 September 2002;

DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.0730-7659.2006.00085.x About DOI