A Comparison of "Hands off" Versus "Hands on"(Ritgen) Techniques on Perineal Trauma During Birth in Nulliparous Women

Perineal trauma usually occurs during childbirth and associates with short and long term complications for women. Blood loss, urinary, faecal and sexual incontinence are effects of after childbirth complications of perinal trauma. These can cause maternal and newborn morbidity. This study wanted to compare the effectiveness of two techniques for perineum protection" hands off" versus "hands on"(Ritgen) during childbirht from view points of frequency, degree and suture of perineal trauma. This randomized clinical trial study carried out on 70 nulliparous women that expecting normal birth of a singleton. They were randomly selected and divided in hands off and hands on (N = 35) groups. In the 'hands on' method, midwife put pressure on the baby's head and support ('guard') the perineum; then lateral flexion is used to facilitate delivery of the shoulders, and in the 'hands off' method, midwife keep her hands poised, not touching the head or perineum, allowing spontaneous delivery of the shoulders. We analyzed data with descriptive statistical methods, t-test, chi-squer, mann whitney and non parametric tests by SPSS. Rates of intact perineum was significantly higher in the 'hands off' group (50%, 40%, p = 0.48). The first and second degree tears were significantly lower in the 'hands off' group (40.6%, 50%, vs, 9.4%, 10%, p = 0.48). We did not observe any significant differences in the rate of lacerations in the anterior regions of the perineum and frequency of suture between the two groups The hands off technique in the second stage of labour increases the likelihood of an intact perineum.