PERINEUM PROTECTION THROUGH RESCUE HAND POSITION: AN ANALYSIS OF IMPACT AND CLINICAL OUTCOMES

Abstract

Abstract. Perineal rupture is known as one of the main causes of postpartum hemorrhage, including tears in the perineal tissue between the vulva and anus that occurs when the fetal head and shoulders pass through the birth canal. The incidence of perineal lacerations increases sharply during rapid and uncontrolled second-stage labor, especially when positioning and hand pressure are suboptimal. According to the POPRACT study (2020), maternal positioning with good sacral flexibility can significantly reduce the risk of second-degree lacerations.   Based on the results of observations at several maternity clinics, out of 50 mothers giving birth, 60% of them experienced spontaneous perineal tears. This was because the attendants in preparing for the delivery of the baby did not comply with the APN technique, so the risk of perineal tears was greater. The purpose of this study was to determine the impact and clinical outcomes of perineal protection through the position of the rescuer's hands on perineal rupture. The research method used in this study was observational. The population in this study was all midwives who assisted spontaneous deliveries at the Asy Safira Clinic, using a total sampling technique taken using consecutive sampling based on a predetermined time. The results of the study showed that most of the second stage birth attendants' hand positions did not comply with the APN of 21 people (55.3%). 50% of cases of normal delivery assistance resulted in second-degree perineal tears. The results of the analysis using chi-square, obtained a significance number (p value) = 0.550 and. Because the p value <0.05, which means that "protection of the perineum through the position of the attendant's hands has an impact and clinical results on the incidence of perineal rupture".These results indicate that the hand position of the birth attendant significantly influences the incidence of perineal tears, with an odds ratio (OR) of 10.667 (95% CI: 1.227–110.953). This indicates that proper hand position can reduce the risk of perineal tears by up to 10.667 times.