Measuring perineum pressure through midwife's hand during shoulder delivery

Statement of the Problem<br>Traditionally, midwives have relied on their intuitive knowledge honed by practical experience and base-line formal education in actively delivering the shoulders of infants, however that knowledge is not evidence-based. Midwives questioned whether or not waiting for the shoulder is superior in outcome to applying perineal pressure during shoulder delivery.<br>Purpose<br>To measure perineum pressure of the midwife's hand during waiting for shoulder delivery compared to the perineal pressure during shoulder delivery as taught in the traditional midwifery textbooks.<br>Method<br>Of the 63 close to term subjects recruited, 60 met the inclusion criteria and agreed to be in the study. The 21 primiparas and 20 multiparas were expediently allocated into group A or B. This descriptive study used engineering equipment named ‘prescale’ to measure the perineal pressure. In the waiting for shoulders method (group A), the left hand of the midwife only touched the infant's head and the right hand was placed against the perineum, while waiting until shoulder delivered. In the traditional method (group B), the midwife's left hand put pressure on the infant's head, and her right hand was placed against the perineum. Midwives get ‘prescale gloves’ on their bilateral palms and help shoulder delivery, then estimate the pressure on shoulder delivery through the gloves.<br>Results<br>The sites of pressure on bilateral palms were different between group A and group B during shoulder delivery. Group B had significantly higher bilateral palm pressure compared to group A. The pressure range of the right hand in group B was from 0.05×10^-2MPa to 3.52×10^-2MPa, especially the tip of forefinger and second finger, the ball of forefinger and little finger were the highest pressure. The left hand was from 0.6×10^-2MPa to 4.29×10^-2MPa. The tip of second finger was the highest pressure of all sites of bilateral palms. In contrast, the pressure range of the right hand in group A was from 0.25×10^-2MPa to 3.05×10^-2MPa, especially the ball of the forefinger, the ball of thumb and little finger were higher than other site. The left hand was from 0.2×10^-2MPa to 2.25×10^-2MPa ; especially thumb was the highest pressure. No significant differences in neonatal outcomes and perineal trauma were observed between the two groups.<br>Conclusions<br>The data showed the region of both midwife's hands and the amount of pressure at shoulder delivery. The pressure of both hands in group B was higher than that of group A. These results indicate particularly how to use midwives' hand.