Perineal protection and management of the fetus in normal birth: a comparative study of two techniques

Maneuvers related to the protection of the perineum and active management of the fetus at the moment of birth were adopted in obstetrics, even when there was little scientific evidence to indicate their use. These procedures may be associated with a greater frequency and degree of perineal lacerations. The objetives of this study were to verify the frequency and degree of perineal laceration, identifying the location of laceration and associating the vitality of newborns who had normal births with the techniques- whether expectant (hands poised) or interventionist (hands poised)- of perineal protection and management of the fetus. This is an experimental, controlled randomized, of the clinical essay type, undergone by means of a quantitative approuch. It was undertaken in the Birth Center of the Itapecerica da Serra General Hospital. This hospital is a public institution of São Paulo State, which is administered by a social health organization. The sample consist of 70 patients, 35 per group, considering Group 1 as those on which the expectant technique of perineal protection was applied, and Group 2, the group on which an interventionist approach to perineal protection was endeavored. The population study was also divided in two groups, Group A and B, according to whether or not active management of the fetus was utilized during childbirth. Data was colleted by obstetric nurses working in the Birth Center during the year 2001. The results demonstrate that 81,4% of the women giving birth suffered some degree of perineal laceration. First-degree lacerations predominated (82,5%), with a similar frequency of anterior and posterior tears, with no statistically significant difference among the four groups. Vitality was preserved among all newborns, with average Apgar tests of 8.7 and 9.6, respectively on the first and fifth minute after birth. We consider that prevention of perineal trauma may be more associated to the position of the mother during childbirth, the use of oxytocin, the type of bearing-down efforts and emotional support during childbirth than to the technique of perineal protection or of the management of the fetus.