A randomized trial of birthing with and without stirrups.

OBJECTIVE: The objective of the study was to determine whether bed delivery without stirrups reduces the incidence of perineal lacerations compared with delivery in stirrups. STUDY DESIGN: In this randomized trial, we compared bed delivery without stirrups with delivery in stirrups in nulliparous women. The primary outcome was any perineal laceration (first through fourth degree). RESULTS: One hundred eight women were randomized to delivery without stirrups and 106 to stirrups. A total of 82 women randomized to no stirrups (76%) sustained perineal lacerations compared with 83 in women allocated to stirrups (78%) (P = .8). There was no significant difference in the severity of lacerations or in obstetric outcomes such as prolonged second stage of labor, forceps delivery, or cesarean birth. Similarly, infant outcomes were unaffected. CONCLUSION: Our results do not incriminate stirrups as a cause of perineal lacerations. Alternatively, our findings of no difference in perineal lacerations suggest that delivering in bed without stirrups confers no advantages or disadvantages.

Perceptions of care in women sent home in latent labor.

PURPOSE: To assess perceptions of care from woman discharged from an obstetrical (OB) triage unit or a labor and delivery unit with a diagnosis of false or latent labor in order to determine factors that may increase or decrease the woman's satisfaction with care. STUDY DESIGN: Descriptive, convenience sample. METHODS: One hundred low-income pregnant women at term presenting for care in latent labor consented to participate in a telephone survey. The survey was based on the relevant research about care of women in early labor and the Donabedian quality improvement framework assessing structure, process, and outcomes of care. RESULTS: Forty-one percent of women did not want to be discharged home in latent labor. Common reasons included women stating they were in too much pain or they were living too far from the birth setting. Eating, drinking, and comfort measures were the most common measures women cited that would have made them feel better when in the hospital. A reoccurring response from women was their desire for very clear and specific written instructions about how to stay comfortable at home and when to return to the hospital. CLINICAL IMPLICATIONS: Comfort measures in the birth setting, including in triage, should include a variety of options including ambulation and oral nutrition. Detailed and specific written instructions about early labor and staying comfortable while at home have value for women in this survey regarding their perceptions of care. Results from this survey of low-income women suggest that a subset of women in latent labor just do not want to go home and this may be related to having too much pain and/or travel distance to the hospital. Hospital birth settings also have an opportunity to create a care environment that provides services and embodies attributes that women report as important for their satisfaction with care in latent labor.

Congenital Reproductive Abnormalities.

Congenital defects of the reproductive system are associated with a number of adverse health consequences. The pathophysiology of these defects is thought to be müllerian abnormalities, but they can also be attributed to failure of cells to degenerate appropriately during embryogenesis. The management of these congenital defects is dependent on the type of defect present and the severity of presentation. Women with congenital defects of the reproductive system have physical as well as psychosocial issues that must be addressed, and the condition frequently creates medical challenges for health care providers.