| ObjectivesBy comparing the effects of free posture combined with self-control breath holding and exertion with other postures and exertion modes on maternal and infant outcomes,pain and subjective fatigue during delivery,the effects of new postures and exertion modes on the second stage of delivery of primipara were discussed.MethodAccording to the inclusion and exclus:ion criteria,480 full-term primipara who were admitted to the maternity ward in the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University from March 2015 to March 2018 without pregnancy complications,complications and contraindications of analgesia during childbirth were selected as the study subjects.The subjects were randomly divided into randomized controlled trial and controlled trial.For routine group,free posture group,self_exertion group and combined intervention group,120 cases in each group.In the course of the study,24 samples were taken.The final results were 110 in routine group,115 in free posture group and self-determination.114 cases in the forced group and 117 cases in the combined intervention group were included in the study.The first and third stages of labor in four groups were given normal and painless routine nursing care.The second stage of labor in the routine group was given the guidance of lying-in position and midwives to hold their breath immediately after the routine opening of the uterine orifice.The free position group was given vaginal examination for opening the uterine orifice and lower limb muscle strength evaluation above grade IV.The midwives or family members assisted the delivery women in implementing the free body.In the supine position,the puerpera should be instructed to hold her breath when the puerpera has a sense of autonomy.Autonomous force group:through vaginal examination of uterine opening,lying in bed to rest,avoid supine position,wait for the maternal autonomous force sense,follow the maternal autonomous will to use breath holding force.In the combined intervention group,the midwives or family members assisted the parturients in performing free posture and avoiding supine posture.When the parturients had a sense of self-exertion,they should hold their breath and exert their strength according to the parturients' self-willingness.Comparisons:(1)Pregnancy outcomes:spontaneous delivery rate,vaginal delivery rate,cesarean section rate,second stage of labor duration,forced breath holding time,postpartum 2 hours of bleeding,perineal injury;(2)degree of pain in the second stage of labor;(3)degree of maternal fatigue;(4)neonatal outcomes:fetal heart rate,neonatal asphyxia rate,umbilical cord artery blood gas analysis results,neonatal birth injury(Incidence of intracranial hemorrhage grade ? or above)clavicular fracture and brachial plexus inj ury.Results:Comparisons of pregnancy outcomes among four groups of parturientsThere were statistical differences in the rate of spontaneous delivery and cesarean section among the four groups.The natural delivery rate of the combined intervention group,free posture group and self-exertion group was higher than that of the conventional group(P<0.05);the cesarean section rate and the rate of assisted devices were lower than that of the conventional group(P<0.05);the natural delivery rate of the combined intervention group was higher than that of the free posture group and the self-exertion group(P<0.05);the cesarean section rate and the rate of assisted devices were lower than that of the free posture group and the self-exertion group(P<0.05);the comparison between the free posture group and the self There was no significant difference in the rate of spontaneous delivery,cesarean section and the rate of assisted delivery(P>0.05).There were significant differences in the duration of the second stage of labor and the duration of forced breath holding between the four groups(P<0.05).The combined intervention group,the free position group and the self-exertion group were shorter than the conventional group(P<0.05);the combined intervention group was shorter than the free position group and the self-exertion group(P<0.05);there was no significant difference between the free position group and the self-exertion group(P>0.05).There was significant difference in the amount of postpartum hemorrhage between the four groups at 2 hours(P<0.05).The combined intervention group,the free position group and the self-exertion group were less than the conventional group(P<0.05);the combined intervention group was less than the free position group and the self-exertion group(P<0.05);there was no significant difference between the free position group and the self-exertion group((P>0.05).The incidences of lateral episiotomy and perineal laceration in the four groups were significantly different(P<0.05).The incidences of perineal laceration in the combined intervention group,the free position group and the self-exertion group were higher than those in the conventional group(P<0.05).The incidences of perineal laceration in the combined intervention group,the free position group and the self-exertion group were higher than those in the combined intervention group(P<0.05).The proportion of perineal I degree laceration in the combined intervention group was higher than that in the free position group and the self-exertion group(P<0.05).There was significant difference in the ratio of severity of laceration among the three groups(P<0.05).There were 7 cases of perineal integrity in the combined intervention group,5 cases in the free position group,4 cases in the self-exertion group and 3 cases in the conventional group.The perineal integrity rate in the combined intervention group was higher than that in the other three groups,but there was no significant difference among the four groups(P>0.05).There were no median incision,third degree and ? degree perineal laceration in the four groups.There was no significant difference in the degree of pain in the second stage of labor between the four groups(P>0.05).There were statistical differences in the degree of maternal fatigue among the four groups.The combined intervention group,the free position group and the self-exertion group were lower than the conventional group(P<0.05);the combined intervention group was lower than the free position group and the self-exertion group(P<0.05);there was no significant difference between the free position group and the self-exertion group(P>0.05).4.Comparison of neonatal outcomes in four groups4.1 There were significant differences in the incidence of normal fetal heart rate and type ?monitoring among the four groups(P<0.05).The incidence of normal fetal heart rate in the combined intervention group,free posture group and self-exertion group was higher than that in the conventional group(P<0.05).Compared between the groups,the fetal heart rate in combined intervention group and the free posture group were higher than those in the self-exertion group,with statistical significance(P<0.05);there was no significant difference between the combined intervention group and the free posture group(P>0.05);the incidence of type ? monitoring of fetal heart rate was higher in the combined intervention group,the free posture group and the self-exertion group compared with the conventional group(P<0.05).There was no significant difference among the combined intervention group,the free position group and the self-exertion group(P>0.05).4.2 The situation of neonatal asphyxia in the four groups:zero case of mild asphyxia in the combined intervention group,one case of mild asphyxia in the self-exertion group,two cases in the free position group and 1 case in the routine group.There was no severe asphyxia in the four groups.There was no significant difference in the rate of neonatal ventricular asphyxia among the four groups(P>0.05).4.4 There was no neonatal birth injxury in the combined intervention group and the self-exertion group.There was one case of neonatal scalp hematoma in the free posture group and 4 cases of neonatal scalp hematoma in the conventional group.There was no significant difiference in the incidence of neoratal birth injury among the t.hree groups(P>0.05).ConclusionThe implementation of free posture and self-control breath holding during the second stage of painless childbirth can help most mothers find the right time to exert tihemselves and effective ways to wait for delivery in the second stage of labor,avoid the adverse effects of mother and infant,and promote natural childbirth. |
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