The influence of free position delivery on maternal labor pain, labor control, maternal and infant outcomes and pelvic floor muscle function / 中国医师进修杂志

ABSTRACT

Objective:To investigate the influence of free position delivery on maternal labor pain, labor control, maternal and infant outcomes and pelvic floor muscle function.Methods:Forty-eight pregnant women who took delivery in free position in the Third People′s Hospital of Bengbu from April to December 2018 were selected as the study group, and 48 pregnant women who took sitting position delivery at the same period were selected as the control group at a 1∶1 ratio. The pregnancy outcomes of the two groups were compared. The duration of labor time and the amount of bleeding were observed. Simplified McGill Pain Questionnaire (SF-MPQ) and labor agentry cale (LAS) were used to evaluate the pain and the labor control of mothers 2 h after delivery. The neonatal asphyxia was evaluated by neonatal Apgar score. The Hamilton anxiety scale (HAMA) and the Hamilton depression scale (HAMD) were used to evaluate the anxiety and depression status of mothers in the two groups 6 weeks after the delivery. The pelvic floor muscle function of the pregnant women in the two groups was compared 6 weeks after the delivery.Results:The rate of maternal transfer to cesarean section in the study group was lower than that in the control group [4.17%(2/48) vs. 16.67%(8/48)] , and the difference was statistically significant ( χ2 = 4.019, P = 0.045). The time of the first and the second stage of labor, the total duration of labor, and the amount of bleeding in the study group were lower than those in the control group [(472.69 ± 55.24) min vs. (515.25 ± 67.26) min, (43.26 ± 5.23) min vs. (52.34 ± 5.56) min, (535.24 ± 38.22) min vs. (582.68 ± 40.16) min, (179.12 ± 25.65) ml vs. (195.34 ± 24.31) ml], and the differences were statistically significant ( P<0.05). There was no statistically significant difference in the time of the third stage of labor between the two groups ( P>0.05). After the delivery, the scores of verbal response scale (VRS), visual analogue scale (VAS), present pain intensity scale (PPI) and HAMA, HAMD in the study group were lower than those of the control group [(6.24 ± 1.21) scores vs. (7.68 ± 1.32) scores, (21.25 ± 2.98) scores vs.(27.95 ± 3.75) scores, (2.78 ± 0.29) scores vs. (3.49 ± 0.85) scores, (6.35 ± 0.18) scores vs. (7.54 ± 0.16) scores, (4.38 ± 0.12)scores vs.(5.54 ± 0.25) scores], the score LAS in the study group was higher than that of the control group [(175.18 ± 15.64) scores vs. (122.65 ± 14.85) scores], and the differences were statistically significant ( P<0.05). The Apgar scores of neonates in the study group was higher than that of the control group at 1 min and 5 min after the delivery, but there was no statistically significant difference ( P>0.05). There was no statistically significant difference in abnormal pelvic floor muscle strength, muscle strength fatigue and abnormal vaginal pressure between the two groups ( P>0.05). The incidence of adverse outcomes in the study group was lower than that in the control group [13.04%(6/46) vs. 35.00%(14/40)] ( P<0.05). Conclusions:Free posture delivery can reduce the rate of transfer to cesarean section, shorten the delivery process, and reduce the amount of bleeding. It also can alleviate the anxiety, pain of mothers, increase the labor control, and reduce the incidence of adverse labor outcomes, but its impact on maternal pelvic floor muscle function needs to be further explored.