| 【Objective】This study compares the effects of epidural labor analgesia who use the free postures or supine position on delivery mode,rate of neonatal asphyxia,side effects,labor pain,feeling in control during labor and the primiparas in different stages of labor preference for choosing position who used free postures,and to provide scientific basis for postural activity with epidural analgesia.【Methods】The convenience sampling method was used to select 140 primiparas who used epidural labor analgesia in the obstetrics department from August 2019 to September2020.The primiparas were grouped according to the order before and after entering the delivery room.Intervention group can choose positions that they can according their preferences or the comfort levels.The control group can use supine and lateral position in the first stage of labor,and in the second stage of labor use dorsal position.Analyze the childbirth outcome,neonatal asphyxia and adverse reactions of the two groups.the VAS of each time and the total LAS score.Record the primiparas preference for choosing position to use in the first and second stages of the intervention group.To further verify the feasibility of using different maternal positions in the first and second stages of labor for epidural labor analgesia primiparas.【Results】1.There was have no statistical differences between the two groups in general demographic information and specialized data(P>0.05).2.Comparison of delivery modes of primiparas in different delivery positionsThere was have no statistical differences in vaginal birth,cesarean section and Instrumental assisted delivery(P>0.05),The intervention groups were 96.9%,1.5%and 1.5%.There were 90.6%,6.3%and 3.1%in the control group.It is believed that in this study,the use of free positions delivery in the intervention group has no effect on the delivery modes.3.Comparison of duration of labor in primiparas with different delivery positionsIn the intervention group the duration of the first and second stage of labor were[440.00(330.00,566.25)]min and[50.00(32.25,77.00)]min.In the control group were[485.00(431.25,581.25)min and[64.00(45.25,96.75)]min.It was considered that the intervention group could effectively reduce the duration of first stage labor(Z=-2.311,P<0.05)and he duration of second stage labor(Z=-2.178,P<0.05).4.Comparison of the rate of clitoral shedding and the rate of clitoral injuries in the primiparas in different delivery positionsThere was no significant difference between the different degree perineal lacerations rate in the intervention group and the control group(Z=-0.693,P>0.05);The two groups had a clitoral shed rate of 20.3% and 45%,respectively,and thought that the free positions could reduce the clitoral shedding rate((?)~2=7.151,P<0.05).5.Comparison of the use rate of oxytocin during childbirth in primiparas with different delivery positionsThe rate of oxytocin in the two group were 23.4%and 41.7%,It was considered that the intervention group could reduce the use of oxytocin during labor(c~2=7.277,P<0.05).6.Comparison of neonatal asphyxia rate among primiparas with different delivery positionsThe results showed that there was no severe asphyxia in this study.The difference in mild asphyxia rates was not significant in two groups(c~2=0.310,P>0.05),were9.4%and 10.0%.It is believed that in this study,the intervention group using free positions have no effect on neonatal asphyxia rate.7.Comparison of adverse reaction rates of primiparas in different delivery positionsThere was no hypotension in this study.There was have no statistical differences in nausea and vomiting rates.(P>0.05).Nausea rate was 3.1%and 5.0%,and vomiting rate was 1.6%and 3.3%.The rate of urinary retention was 20.3%and 38.3%,and suggesting that the intervention group could reduce the retention of urine at labour(c~2=4.881,P<0.05).8.Comparison of childbirth pain(VAS)in primiparas with different delivery positionsThe VAS of the intervention group at 120min[2(2,3)]were higer than control group(Z=-2.714,P<0.05),10cm of cervical dilation[5(4,5)]were higer(Z=-3.263,P<0.05),the head visible on vulval gapping[5(5,6)]were higer(Z=-3.387,P<0.05)and the number of Automatic analgesia pump[0(0,0)]were lower(Z=-2.463,P<0.05),it means that the intervention group could alleviate the pain of childbirth.9.Comparison of the score of LAS in primiparas with different delivery positions.The score of LAS in the intervention group[148.5(131.25,179.00)]was higher(Z=-2.548,P<0.05)),it means that the intervention group could improve feeling in control during labor.10.The position selection of primipara in free posturesDuring the first stage of labor,all primiparas in the intervention group changed at least one delivery position except supine and lateral position,and the majority of the changed positions were upright position,for example sitting position(78.1%)and standing position(67.1%).The majority of the primiparas chose lateral position(62.5%)and squatting position(59.4%)in the second stage of labor.The final delivery position was mainly in side lying position(76.5%)and supine position(21.9%).【Conclusions】1.Free postures with epidural analgesia of primipara is worth recommended.It can promote labor,shorten the duration of labor,reduce the use of oxytocin and the occurrence of urinary retention during labor,reduce the intake of analgesic drugs,avoid unnecessary medical intervention2.Free postures with epidural analgesia of primipara can improve the delivery experience of primipara.The study shows that it can further alleviate labor pain,enhance feeling in control during labor,improve maternal labor experience.3.Midwives give guidance according to the needs of primipara in different labor positions which is conducive to the creation of a more humanized delivery mode.The first position of labor which can alleviate lumbosacral discomfort and enhance comfort.For the second stage of labor which is to facilitate exertion and control the delivery speed.The final delivery position which is easy to control the force and delivery. |
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