Maternal Position at Midwife-Attended Birth and Perineal Trauma: Is There an Association? Barbara Soong, RM, IBCLC, MHA, and Margaret Barnes, RM, MA, PhD ABSTRACT: Background: Most women will sustain some degree of trauma to the genital tract after vaginal birth. This study aimed to examine the association between maternal position at birth and perineal outcome in women who had a midwife-attended, spontaneous vaginal birth and an uncomplicated pregnancy at term. Methods: Data from 3,756 births in a major public tertiary teaching hospital were eligible for analysis. The need for sutures in perineal trauma was evaluated and compared for each major factor studied (maternal age, first vaginal delivery, induction of labor, not occipitoanterior, use of regional anesthesia, deflexed head and newborn birth- weight >3,500 g). Birth positions were compared against each other. Subgroup analysis deter- mined whether birth positions mattered more or less in each of the major factors studied. The chi- square test was used to compare categorical variables. Results: Most women (65.9%) gave birth in the semi-recumbent position. Of the 1,679 women (44.5%) who required perineal suturing, semi-recumbent position was associated with the need for perineal sutures, whereas all-fours was associated with reduced need for sutures; these associations were more marked in first vaginal births and newborn birth weight over 3,500 g. When regional anesthesia was used, semi-recumbent position was associated with a need for suturing, and lateral position associated with a reduced need for suturing. The four major factors significantly related to perineal trauma included first vaginal birth, use of regional anesthesia, deflexed head, and newborn weight more than 3,500 g. Conclusions: Women should be given the choice to give birth in whatever position they find comfortable. Maternity practitioners have a responsibility to inform women of the likelihood of perineal trauma in the preferred birth position. Ongoing audit of all clinicians attending births is encouraged to further determine effects of maternal birth position and perineal trauma, to investigate women’s perception of comfortable positioning at birth, and to measure changes to midwifery practice resulting from this study. (BIRTH 32:3 September 2005) Childbirth should be a time for joy and celebration, but most women will sustain some degree of trauma to the genital tract after vaginal birth, with higher rates especially after first vaginal births and instru- mental delivery (1). Short and long-term problems include perineal pain (1–3), difficulties with mobiliza- tion, and limitations in feeding positions in the post- natal period. Protracted pain can affect urinary, bowel, and sexual function over the long term (1,2). Perineal trauma was the most frequently reported complication of labor and birth in the Queensland Perinatal Data Collection in 1996, with 46.6 percent of all public-accommodated mothers delivering in Barbara Soong is a Clinical Midwife Consultant, Mater Mothers Hospital, Brisbane, and Margaret Barnes is a Senior Lecturer in the School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia. The study was funded in part by the Australian Midwifery Scholarship Program, Australian College of Midwives, Canberra, Australian Capital Territory, Australia. The views expressed here are those of the authors and do not necessarily reflect those of the Mater Health Services, Brisbane, Queensland, Australia. Address correspondence to Barbara Soong, Department of Maternal Fetal Medicine, Mater Mothers Hospital, Raymond Terrace, South Brisbane, Queensland, 4101, Australia. Ó 2005 Blackwell Publishing, Inc. 164 BIRTH 32:3 September 2005