The Final Stretch: Range of Normal Perineal Changes During Second Stage Labor in First Vaginal Birth

The Final Stretch: Range of Normal Perineal Changes During Second Stage Labor in First Vaginal Birth: "Purpose: The aim of this descriptive, observational study is to identify the range of perineal changes during second stage labor and associated perineal outcomes. Background: Many women fear pelvic floor damage as a consequence of vaginal birth despite limited evidence of a causal link between vaginal birth and pelvic floor damage. Documentation of the process of perineal stretch, which is presumably when damage would occur, is absent from the literature. Methods: Eighteen nulliparas were observed during second stage labor. Documentation of position, pushing, time of vertex being visible, crowning, rate of distention, color changes and blanching was noted with each push. Descriptive statistics were calculated. Results: Second stage length ranged 15-281 minutes (mean 94). Ratio of time the vertex was visible to a sustained crown was 0% to 75% of the total time in second stage. The ratio of time spent with the vertex in a sustained crown ranged from 3% to 48% of second stage duration. Despite variance in duration of stretch, longer duration did not correlate with perineal trauma. Blanching, duration of active pushing, and rate of distension were associated with increased risk of trauma. Conclusions: A wide range of “normal” perineal changes during second stage was documented that do not lead to lacerations. Future studies should identify opportunities to prevent perineal trauma beyond focusing duration of perineal stretching."

Men Suffer from Prenatal and Postpartum Depression, Too; Rates Correlate with Maternal Depression

Men Suffer from Prenatal and Postpartum Depression, Too; Rates Correlate with Maternal Depression: "Paternal depression has often taken a back seat to the studies of maternal and postpartum depression despite recognition that depression among fathers negatively affects family life. Although the primary focus of our care as midwives and women's health clinicians is directed at women and mothers, we view our work as that which promotes and strengthens families; however, “family” is defined by women in our care. Although depression among fathers is not well understood and the literature on this topic is emerging, Paulson and Bazemore wanted to describe what is known about paternal depression and its association with maternal depression using techniques of metaanalysis. The primary outcome for this study was described as a point prevalence rate, defined by the authors as cases of depression divided by the number of study participants. The rate of depression among female partners was a secondary outcome."

Comfort Measures for Childbirth

Comfort Measures for Childbirth: "Penny Simkin introduces her DVD by stating that her intent is to demonstrate techniques to help laboring women cope with their pain and hence alleviate the concept of suffering. Simkin gives a brief overview of her belief in the 3Rs—Relaxation, Rhythm, and Ritual—and their role in pain management, along with a supportive partner, and a little luck! The organization of the remainder of the DVD is clear and logical, with four distinct sections: 1) basic relaxation and rhythmic breathing; 2) comfort measures, devices, and positions; 3) techniques for back pain and labor progression; and 4) positions and techniques for squatting and birth. Simkin begins each section with a brief introduction. Videos and photographs of actual labors demonstrate the techniques being used. This DVD replaces Simkin's 1995 video of the same name. The DVD is both extended and enhanced, with a seemingly daunting running time of 91 minutes. However, the user-friendly menu allows the viewer to access each section or even each position or technique individually."