Clinical Study Of Free Posture For Primipara During Labor Analgesia

Objective:This research is to compare the effect on delivery analgesia and the delivery process between the free position and the traditional posture,to further clarify the feasibility and safety of the free position,provide clinical basis for the promotion and application of free posture in analgesic labor.Methods:According to the inclusion and exclusion criteria,from 2016.06 to 2016.12 in the maternity hospital affiliated to Nanjing Medical University,184 cases of primipara treated by vaginal painless delivery were chosen as the research object,non randomized controlled study method,on the premise of informed consent of the patients,the subjects were divided into two groups according to their own willingness:Experimental group(applying free body position for delivery)and Control group(applying traditional position for delivery),92 cases for each group.In the course of the study,due to that 3primiparas gave up the application of the free position during the delivery process,so 3 cases in the experimental group were abandoned.As a result,89 cases in the experimental group and 92 cases in the control group were compared.Experimental group:professional midwife guide primipara the free positions such as lying,sitting,standing,clinostatism,squatting,semi prone position,as well as sit ball,swing hip and slow dancing,of which right position is chosen by the primipara,mainly according to their own comfort and self strength support.Control group:professional midwife guide primipara the traditional body position,such as supine position and alternating left and right side position.Contrasting(1)baseline data:age,gestational week,history of abortion or not,height,weight before delivery of primipara,and fetal weight shown by B-mode ultrasonography;(2)the average time of the first,second,and third stage of labor,and the average bleeding volume after 2 hours postpartum as well;(3)fetal heart rate,recovery of fetal heart rate,shoulder dystocia rate and neonatal asphyxia rate;(4)midwifery satisfaction of delivery position of primipara,pain score;(5)forceps delivery rate,cesarean section rate and oxytocin usage;(6)the lateral episiotomy rate and extent of perineal injury.Results:1.There exists no statistical variationon age,gestational week,history of abortion or not,height,weight before delivery of primipara,and fetal weight shown by B-mode ultrasonography between these two groups,which is comparable.(P>0.05)2.Comparation between the two groups on the average time of the first,second and third stage of labor,and the average bleeding volume after 2 hours postpartum as well:(1)The average time of the first,second and third stage of labor:Experimental group come out with the result of 8.39±2.34 hours,28.62±6.85 minutes,7.94±2.59 minutes;while the control group result were 9.07±2.06 hours,32.56±9.56 minutes,9.29±3.02 minutes.The labor time of the experimental group was significantly less than that of the control group,and there was statistical difference between the two groups.(P<0.05).(2)The average bleeding volume after 2 hours postpartum:Experimental group was 201.23±51.23ml,while 223.21±51.12ml in the control group.The experimental group had the less amount of bleeding,so there was statistical difference between the two groups(P<0.05).3.Comparation between the two groups on fetal heart rate,recovery of fetal heart rate,shoulder dystocia rate and neonatal asphyxia rate:(1)Fetal heart rate:In the experimental group,34 cases occurred,and the probability was 38%;while 50 cases occurred in the control group,and the probability 54%.The incidence of fetal heart rate of the experimental group was significantly lower than the control group(x2 =4.13,p = 0.04),and there was statistical difference between the two groups(P<0.05).(2)Fetal heart recovery rate:experimental group was 94%,while control group was 80%.The occurrence rate of recovery of fetal heart was much more possible by changing the position(x 2= 4.03,p=0.04),and experimental group was higher than the control group,and the difference was statistically significant(P<0.05).(3)Shoulder dystocia rate:The occurrence rate of shoulder dystocia of experimental group was lower than that of the control group,and there was statistical difference.(4)Neonatal asphyxia rate:There was only one neonatal asphyxia(Apgar ?7)in the experimental group,while 11 cases of neonatal asphyxia in the control group(Apgar ?7),and the difference was statistically significant(P<0.05).4.Comparation of midwifery satisfaction of delivery position of primipara and pain score:(1)The satisfaction degree in experimental group(79%)was obviously better than in control group(54%),and there was difference between the two group(P<0.05),which is statistically significant.(2)The pain score of the experimental group was lower than that of the control group,and the difference was statistically significant.(P<0.05)5.Comparation of forceps delivery rate,cesarean section rate,and oxytocin utilization rate:(1)Forceps delivery rate:3.4%in the experimental group,while 10.9%in the control group,and the forceps delivery rate of the experimental group was much lower compared to that of the control group(p<0.05),of which difference was statistically significant(x2=4.54,p=0.03).(2)Cesarean section rate:the rate of cesarean section delivery was 2.2%in the experimental group,while 10.9%in the control group.The rate of cesarean section delivery in the experimental group was significantly lower than that in the control group(x2=5.43,p=0.01).The difference was statistically significant(P<0.05).(3)Oxytocin utilization rate:In the experimental group,the result was 26.96%,while 42.68%in the control group,the difference was statistically significant(P<0.05).6.Comparation of the lateral episiotomy rate and extent of perineal injury:(1)The rate of episiotomy:In the experimental group,the result was 35.63%,while 60.98%in the control group;and the rate of episiotomy in the control group was higher than the experimental group(x2=10.86,p=0.01).The difference was statistically significant(P<0.05).(2)Perineal injury degree:There was statistical difference on the extent of perineal injury between the two groups(P<0.05).Conclusions:1.Primipara to take the free position delivery,can not only shorten the time of the first,second and third stage of labor,but also can effectively reduce the cesarean section rate,forceps delivery rate,neonatal asphyxia rate,lateral episiotomy rate,shoulder dystocia rate,and bleeding volume after 2 hours postpartum as well.2.Compared with the traditional posture delivery,free posture increases the comfort and satisfaction of primipara.It is a simple,effective and non-invasive method of delivery.