Comparative study of the effect of using lithotomy, squatting and sitting positions in the second stage of physiologic delivery on severity of pain and outcome of childbirth in primiparous women

Determining the effects of squatting, sitting and supine (lithotomy) positions on the severity of pain and duration of latent and active phase of the second stage of labor in primipara women

The clinical trial included two intervention groups and one control groups, with parallel groups, randomized, 96 samples, sampling from 30/11/2010 to 22/09/2011

This is a clinical trial conducted on the primiparous women referring to Shahid Beheshti hospital affiliated to Isfahan University of Medical Sciences and Ostad Motahari hospitals affiliated to Jahrom University of Medical Sciences in 2010-2011. Based on the inclusion criteria and obtaining a written consent of the samples about how to do the study, information about pain intensity of the latent and active phase of the second stage of labor, the severity of pain in the third stage of labor, the duration of the latent phase and the active phase of the second stage of labor, the duration of the third stage of labor, perineum status, type and degree of rupture, through the examination and interview were collected. The severity of pain was measured by McGill's visual analogue scale pain. From the beginning of the study, the researcher used a delivery chart or partograph to determine how progress of labor, maternal and fetal health, or any problems that have occurred during the study. In dilatation of 8-9 centimeters and after engagement or zero station and until the end of the second stage of delivery, the mother was placed in the sitting, squatting and lithotomy position. The length of the latent and active phase of the second stage of labor was measured by a kronometer. During the full cervical dilatation, the kronometer was switched on and immediately upon first observation of the first strong contraction and straining kronometer off and again immediately on and it was shut again When the baby was completely exited, it was extinguished.Thus, the length of the latent and active phase of the second stage would be calculated. In order to determine the amount of bleeding in the first hour after the birth of the baby in all three groups, immediately after the extraction of the baby, one basin was placed under the mother's hips. In the three groups after the extraction of the placenta and its blood completely, the basin was removed and immediately after, the pad which was weighed were placed in the anus and vulva area and if necessary, the pads were replaced. In the next step, the blood inside the basin was transferred to a graded case and then it was measured and recorded. At the end of the first hour after delivery, the pads and gauzes ( which were weighed before by using a digital scale) were weighed again and deducted from the previous weight, and the amount of blood was measured in grams, and according to the blood weight ( per grams) formula, they were divided by total blood concentration (total blood concentration is 1.06), which resulted in blood volume per cc and it was accumulated with the volume of blood measured in the scaled container and the volume of bleeding in the first hour after delivery was obtained ( by cc).

Inclusion criteria: Pregnant women aged between 18-35 years old، primiparous women, gestational age between 37 and 41 weeks, women in dilatation 8-9 cm, singleton pregnancy, fetal presentation (head) in the second stage of labor engagement and at least ischial spines is reached, estimated fetal weight is based on Johnson's law between 2,500-4,000 grams, the tendency and readiness for the physiological delivery; Exclusion criteria: Anatomical and skeletal disorders, lack of labor progress in the first stage of labor, rupture of the water bag over 12 hours, weakness and numbness in the legs (in squat position), short Perinea (vaginal insertion distance to the anal inlet less than 3.5 cm), maternal fatigue at the end of the first stage of labor;

Supine (lithotomy) group: Position of lithotomy in the present study was in the way that the mother was in supine position with 30 head elevation and bent knees. Squatting group: In squatting position, the mother was sitting on her feet so that her sole was in touch with the floor and knee joints were higher than the hips. Sitting group: In sitting position the mother sat on labor chair in the way that her lumbar spines were completely strait and the hip and knee joints were at the same level.

The main consequences include the intensity of the latent and active phase of the second stage of labor, duration of latent phase and active phase of the second stage of labor, duration of third stage of labor, volume of bleeding in the first hour after delivery

In order to randomize in three group every day, the first person in the squatting group,the second person in the sitting position and the third person in lithotomy position were placed