The Natural Delivery Outcome Of Primipara Without Medical Interventions

Objectives:To explore the natural delivery outcome of primipara without medical interventions. Metheds:3000 primiparas who had delivery in our department from January 2013 to December 2014 were randomly divided into two groups:observing group and control group. All primiparas meet the following criterion:single birth, head presentation, the height> 155cm, without communication disorders, each pelvic dimension is normal, BPD?9.8cm, without pregnancy complications, without medical indications of cesarean section. Qbserving group 1500 cases whose labor stages were natural without medical interventions. In the first stage, they had free activities in order to make their pelvic spaces and shapes adapt with the decending of fetal head, having enough food, and water, being accompanied by their family and having a rest with left lateral position. In the process of delivery,they were monitored for fetal heart and labor process by the nurse or midwife, not being made the vaginal examnations if no need. They chose the delivery place according to their wills with the normal fetal heart, waiting for natural rupture of membranes. In the second stage of labor, pregnant women chose the most comfortable delivery positions in line with their wills:semireclining position, lateral position, prone position, sitting position, et al, no perineal protection midwife. During the progressing stage, every pregnant woman was not made perineum expansion, no being helped the plexion and extention of the fetal head, no being intervented the direction and angle of delivery. The midwife communicated with the pregnant woman and guided her the different force of labor in order to make her control the speed of delivery. The best speed was that the enlargement of the fetal head diameter was not exceeding 1cm in every contraction. The fetal shoulder was given birth to slowly till next contraction after the fetal head delivery. In the third stage of labor, the midwife did not cut the umbilical cord until the umbilical pulse disappeared, no manual stripping of the placenta, no regular cleaning uterine cavity, with cleaning uterine cavity if placenta or membrane being residual. Mother contacted with her newborn and the infant sucked early after delivery. The pregnant woman had enough time to try her vaginal labor in the case of maternal and the fetal heart being in good condition. The perineum incision was made according to the strict indications. The control group 1500 cases were given different medical interventions, indution of labor or strengthening the contractions by pitocin,intravenous injection of diazepam and phloroglucinol,artificial rupture of fetal membrane et al.They were given continue fetal heart rate monitoring,reducing activities,staying in the labor room,corresponding treatments when prolonged labor. In the second stage of labor,the midwife guided the puerperal childbirth by semireclining position and how to use the force of labor. In the process of childbirth,the midwife took the following measures:protection of perineum, deciding whether the perineum incision under conditions of fetal size and perineum, helping the plexion and extention of the fetal head, assisting in expelling the shoulder. In the third stage of labor, the midwife generally cut the umbilical cord and promoted the placental delivery after placental separation. The puerperal was cleaned her uterine cavity when her placenta and placental membrane being residual. Mother contacted with her newborn and the infant sucked early after delivery. Results:Mode of delivery and pregnancy outcomes were compared between the two groups. The natural delivery rate, intact perineum rate and apgar score at the 1st min after birth were higher in the observing group than the control group, otherwise the episiotomy rate, perineal second degree laceration rate,cesarean section rate, postpartum bleeding, amniotic fluid pollution rate were lower(P<0.05).There were no significant differences in ages, educational levels, gestational weeks, total labor stages, the time of different stages, amnitic fluid volume, neonatal weight and the number of newborn transferred to NICU, et al. between the two groups (P> 0.05). Conclusions:For low-risk primipara, we can gain better outcome of pregnancy by reducing medical intervention, limiting the perineum incision, decresing cesarean section rate and promoting natural delivery.