Stirrups during childbirth don't cause more tears
Last Updated: 2012-07-13 12:30:41 -0400 (Reuters Health)
By Kerry Grens
NEW YORK (Reuters Health) - Women who have their feet in stirrups during childbirth are no more likely to experience a tissue tear during the delivery than women whose feet are on the bed, according to a new study.
Using stirrups as mothers lie in a semi-reclined position has been a common practice in the United States for the past century or two, said Marie Hastings-Tolsma, a nurse midwifery professor at the University of Colorado Denver. The use of stirrups is helpful when applying interventions, such as forceps or in utero monitoring, said Hastings-Tolsma, who was not involved in the study.
However, there has been a concern that keeping the feet and knees raised during childbirth puts added pressure on the perineum - the tissue between the vagina and the anus - and leads to a greater risk of ripping, said Dr. Marlene Corton, the lead author of the study and a professor at the University of Texas Southwestern Medical Center.
Corton and her colleagues randomly assigned 214 first-time moms to either use stirrups during delivery or to lie in the same position, but to have their feet on the bed.
Corton's group then counted the number of perineal tears that occurred, from 1st degree tears, which are minor rips in the skin, up to the most severe, 4th degree tears that go through the anus.
They found that the two groups had roughly the same number of tears.
In the no-stirrups group, 82 out of 108 moms experienced a tear and 83 out of 106 moms in the stirrups group had a tear.
Hastings-Tolsma said it's possible that the researchers didn't find a difference between the groups because the birthing positions were too similar.
Perhaps the findings would have been different if the no-stirrups group could have chosen a different position.
"There's data that show that side-lying affords protection to the first time mom in terms of reducing the likelihood of lacerations," Hastings-Tolsma told Reuters Health.
Corton said that she still questions whether stirrups can lead to more 3rd and 4th degree tears, but there were too few in her study to answer the question.
Among the no-stirrups group, for instance, five moms had a severe tear, and in the stirrups group, six moms had a severe tear.
Corton said that half of women with such tears will experience anal incontinence within the first few months after giving birth.
She's designing a larger study that will look at the best birthing positions to prevent these types of injuries.
ARE STIRRUPS OUTDATED?
Corton added that while stirrups are still commonly used, and are needed in some situations, they have become outdated for the most part.
They were helpful at a time when women were cut routinely to widen the birth canal, but now that such procedures are rare, stirrups don't seem necessary for most moms.
"What we can say for women who have uncomplicated pregnancies who wish to deliver in a comfortable position in bed is that based on these findings they should be allowed to do so," Corton told Reuters Health.
Hastings-Tolsma agreed that in uncomplicated cases, babies can be delivered just as safely without the use of stirrups.
"If there are no disadvantages to birth without stirrups and no advantages to birth with stirrups, why use them?" she said.
SOURCE: http://bit.ly/NypKxx American Journal of Obstetrics and Gynecology, online June 23, 2012.