Does Use of Stirrups Minimize Perineal Lacerations?

Use of stirrups during bed delivery offers no advantages or disadvantages in terms of the incidence of perineal lacerations, according to the results of a new study.¹ Researchers at the University of Texas Southwestern Medical Center hypothesized that the rate of perineal lacerations would be reduced when bed delivery occurred without the use of stirrups.

Study participants included nulliparous women 16 years or older in spontaneous labor with a single fetus in cephalic presentation at 37 weeks of gestation or greater. Only nulliparous women were included because perineal lacerations are more common in women delivering their first child, explained the study authors. Of the 214 women included in the study, 108 delivered without stirrups, and 106 delivered with stirrups. Overall, perineal lacerations occurred in 145 women who participated in the study. One or more lacerations occurred in 82 women (76%) randomized to no stirrups and 83 women (78%) randomized to use of stirrups. The severity and type of lacerations were similar between study groups. In addition, there was no significant difference in obstetric outcomes in terms of prolonged second stage of labor, forceps delivery, and cesarean delivery. Use of stirrups had no effect on outcomes for the newborns.

In the United States, most hospital births attended by physicians probably involve the use of stirrups, according to the study authors. Because of these study results, the authors question whether stirrups should be used at all in routine deliveries, since their use offers no advantages and their lack of use offers no disadvantages. The authors do state that stirrups are indicated in certain circumstances, including operative vaginal delivery and adequate examination of the perineum and vaginal walls in cases of hemorrhage or laceration.

Pertinent Points:
- Routine use of stirrups offers no benefit to patients in most bed births.
- There was no increase in the rates of first-degree to fourth-degree perineal lacerations in births that did not involve the use of stirrups.

References:

1. Corton MM, Lankford JC, Ames R, et al. A randomized trial of birthing with and without stirrups. Am J Obstet Gynecol. 2012;207:133.e1-5.