Estudio prospectivo de cohortes con dos grupos paralelos de gestantes comparando el modelo de parto utilizado

Abstract

Objective: To compare two models of low risk birth attended by midwives or resident midwives, to evaluate the results of the obstetric variables, in relation to pain, the Apgar test, the affectation of the perineum and the level of satisfaction with the birth process of the pregnant women and the utility of the plan of birth Methodology: This is a prospective cohort study with two parallel groups of pregnant women comparing the model of delivery used. The place of study was the Sant Joan de Deu Hospital in Barcelona. The study was conducted between October 2015 and February 2018. The study population were pregnant women whose pregnancy and delivery was low risk and the care performed by midwives or resident midwives. The total sample was 148 pregnant women, 90 cases of medicalized delivery and 58 of natural birth. All the participants were informed and signed the informed consent. We studied sociodemographic variables, obstetric variables and variables related to the satisfaction with birth process of the pregnant woman in relation to the care of the midwife and the utility of the birth plan. Piloting was carried out with 10 cases from each group with the objective of testing the questionnaires and documents and verifying the functioning of the subjects' collection circuit. An analysis was performed to compare the 2 groups according to a numerical variable and a bivariate analysis using the Student's t-test for comparison of means or the Mann-Whitney U test, according to the distribution of the variable. In case of 3 or more groups the analysis of variance (ANOVA) or the Kruskal-Wallis test was used. In case of categorical variables, the chi-square test or Fisher's exact test was used. Logistic regression models were used and relative risks were calculated for the main outcome variables. Results: No significant differences were observed in maternal age (p = 0.277), marital status (p = 0.467), educational level (p = 0.260), BMI (p = 0.842), gestational age (p = 0.423) or parity (p = 0.065) between the two cohorts. All pregnancies were full term, with cephalic presentation and spontaneous birth. Regarding the birth process, no significant differences were observed in the results of the Bishop test (p = 0.095), although there were significant differences in the time of dilation (p = 0.018) and the artificial rupture of the amniotic sac (p = 0.027). ), being superior in medicalized delivery in the two variables. Pain was significantly higher in the natural delivery group (p = 0.018), depending mainly on maternal age (p = 0.007). As for the integrity of the perineum, episiotomy was performed in 9 cases of medicalized delivery (7.78%) and 1 (1.75%) in those of natural birth, without significant differences (p = 0.510). The use of ambulation as an alternative method for pain approached the significance and was more likely to rupture perineal, regardless of the model of delivery (p = 0.059). The score of the Apgar Test was higher than 8 in all cases, being significantly higher in the model of natural childbirth (p <0.001) and depending on the model of delivery used (p = 0.004), the use of hydrotherapy (p = 0.047) and, approaching the significance, if the woman was second (p = 0.059). Finally, the pregnant women with medical delivery were significantly more satisfied with the birth process (p <0.001) and the women of natural birth found the birth plan (<0.001) more useful. Conclusions: The variable pain had significance in the model of natural childbirth. In the Apgar test, the results were better in natural childbirth, with new borns having a higher score of 10. There was no significance in carrying out the episiotomy in the two birth models. Maternal age was more likely to be painful. Satisfaction with the birth process, was higher in women in the medicalized delivery model. The birth plan was more useful in women of the natural childbirth model, although satisfaction depending on whether they had done it or not, was not showed significant differences.