Application Of Free Position Delivery In Labor Process

Objective:By comparing the effects of lateral position,sitting position,knee and chest position,kneeling position,standing position and traditional position on the puerpera during vaginal delivery,the feasibility and safety of the application of appropriate free position in promoting vaginal delivery in clinic were discussed,and the clinical theoretical basis for the promotion and application of free position was provided.Methods:According to the inclusion and exclusion criteria,a total of 621 parturient women who underwent regular prenatal check-up in Yunnan First People’s Hospital from June 2020 to January 2022 and delivered vaginarily in free position were selected（408 primiparas and 213 parturients）were selected as the free position group.1000cases of parturients（446 primiparas and 554 parturients）who delivered via vagina in traditional bladder lithotomy position were randomly selected as the traditional position group.free position group:Professional midwives shall guide the puerpera to choose the appropriate position according to their own comfort,willingness and exertion,or take the appropriate free position for delivery according to the puerpera’s own situation（baby’s position,or fetal heart rate）,feeling and comfort under the guidance of medical personnal.Puerpera can use（left,right）Lateral position,Knee-chest position（genucubital position）,Sitting position,Kneeling position,Standing position.Traditional position group:professional midwives guided the puerpera to deliver in traditional bladder lithotomy position.Collect,statistics and analyze and compare the general clinical data of puerpera,pregnancy outcome and newborn.Statistics:SPSS 25.0 software was used for statistical analysis.Measurement data conforming to normal distribution were represented by（?）±s（Mean±SD）,inter-group comparison was performed by independent sample T test,non-conforming measurement data were represented by median and quartile（M（P25～P75））,inter-group comparison was performed by rank sum test.Statistical data were compared by X~2 test,P<0.05 was considered statistically significant.Result:1.There were 446 primiparas in the traditional position group and 408 primiparas in the free position group.The time of the second stage of labor in the free position group was lower than that in the traditional position group（P<0.05）,and the difference was statistically significant.There were 554 cases in the traditional position group and 213 cases in the free position group.There was no statistically significant difference between traditional position group and free position group during the second stage of labor.The time of the first stage of labor,the time of the third stage of labor,the time of the total stage of labor,compared buy the traditional position of primipara group and the free position group,P>0.05,the difference was not statistically significant.2.The amount of intrapartum bleeding in the traditional position group was higher than that in the lateral position group,the sitting position group,the knee and chest position group,the kneeling position group and the standing position group,with p value（0.020）<0.05,and the difference was statistically significant.There were no statistically significant differences in 1-hour postpartum blood loss and 2-hour postpartum blood loss between the traditional position group,the lateral position group,the sitting position group,the knee and chest position group,the kneeling position group and the standing position group,with P>0.05.3.VAS scores of the traditional position group were compared with the lateral position group,the sitting position group,the knee and chest position group,the kneeling position group and the standing position group,with p<0.05,indicating statistically significant differences.4.All the birth-giving women in the 5 free position groups did not use forceps to assist delivery,and the rate of forceps to assist delivery was 0.In the traditional position group,forceps assisted delivery in 2 cases,the rate of forceps assisted delivery was 0.2%.There was no grade III or IV tear in the perineum in the traditional position group,the lateral position group,the sitting position group,the knee and chest position group,the kneeling position group and the standing position group.The perineal integrity rate was higher in the lateral position group/kneeling group than in the knee and chest position group/standing group than in the sitting group and higher than in the conventional traditional posture group,with statistical significance.The injury rate of degree II perineum was higher than the conventional position group and others free position group,with statistically significant difference（P<0.05）.Lateral perineal resection rate:the conventional traditional position group was higher than the sitting position group,the knee and chest position group,the lateral position group,the kneeling position group,the standing position group,the difference was statistically significant.Degree I injury of perineum:there was no statistically significant difference between the conventional traditional position group and the lateral position group,the sitting position group,the knee and chest position group,the kneeling position group and the standing position group.5.Apgar score at 1 minute after birth,Apgar score at 5 minutes after birth,and Apgar score at 10 minutes after birth were compared among the traditional position group,side decubitus group,sitting group,knee and chest decubitus group,kneeling group and standing group,with no statistically significant difference（P>0.05）.Conclusion:1.The time of the second stage of labor of primiparas can be shortened by using the appropriate free position delivery according to the situation of primiparas;2.Compared with traditional positions,the amount of bleeding during childbirth in free positions was reduced;3.Labor pain was less in the free position group than in the traditional position group;4.Free position has obvious clinical effect to promote vaginal delivery,delivery free position childbirth puerpera childbirth than traditional position perineum complete rate is high,episiotomy rate,the rate of midwifery drops,thus improve the vaginal births,decrease the rate of cesarean section,make better maternal birth experience,enjoy a higher level of reproductive health rights,At the same time,free position is a suitable technique for primary hospitals,which is worth applicating and promoting in clinic.