Postpartum hemorrhage is one of the leading causes of maternal death worldwide, especially in developing countries, and is responsible for 13% of maternal deaths as well as nosocomial complications [2-6]. In addition, one of the concerns of the first 24 hours after delivery is a decrease in hemoglobin; so routine measurement of postpartum hemoglobin and obstetric and gynecological surgeries is common [7]. Every year, 14 million women suffer from postpartum hemorrhage, of which about 140,000 die. [8] Primary postpartum hemorrhage is the most common form of major obstetric hemorrhage, which involves the loss of 500 mL or more of blood from the genital tract within the first 24 hours after delivery [9]. This is a clinical estimate, and the loss of 500 mL of blood can be life-threatening due to the prevalence of anemia in many parts of the world.
So far, studies have shown that natural childbirth leads to cesarean section due to medical interventions and the use of physiological childbirth. Due to the lack of available information about the effects of delivery method on postpartum hemorrhage and hemoglobin loss and the special importance of mothers, the present study aimed to compare some maternal blood parameters and their neonatal Apgar scores in both conventional and physiological vaginal delivery methods in Fatemieh hospital, in Hamadan, Iran.

 

This semi-experimental study was performed in 2018 with the participation of 400 pregnant women candidates for physiological childbirth and 400 pregnant women candidates for conventional vaginal delivery, using the available sampling method. Mothers in the physiological delivery group were those who did not receive any major labor intervention, and during the labor, training was given on how to breathe, pelvic rotation, delivery ball, hot shower, and massage. In the common vaginal delivery group, the mother went through the usual steps as soon as she was hospitalized. All mothers' intravenous blood samples were examined in two groups to measure the amount of hemoglobin and hematocrit at the time of hospitalization and 6 hours after delivery and the Apgar score of the first and fifth minutes of infancy in both groups. Data were analyzed using SPSS version 16 (SPSS Inc., Chicago, Ill., USA). Kolmogorov-Smirnov test was used to investigate the distribution of quantitative variables. Independent t-test was used to compare demographic and quantitative variables and Chi-square test was used for qualitative variables. Independent t-test, paired t-test and ANOVA were used to compare the mean of hemoglobin and hematocrit in two groups and Fisher’s exact test was used to compare the Apgar scores of minutes 1 and 5. Significance level was considered 0.05.

In the present study, according to the hospital's policies in the prevention of postpartum uterine atony, synthetic oxytocin is used for all mothers, and since the third stage is not physiologically managed in mothers who give birth physiologically, the amount of blood loss expected in the two groups can be similar and this has caused a slight difference in maternal hemoglobin and hematocrit between the two groups.
Also in the present study, the comparison of Apgar scores in minutes 1 and 5 between the two groups showed that the condition of newborns in deliveries performed by physiological methods is better than conventional delivery methods. The results of the present study are consistent with the results of the study of Jahdi et al. as well as Rahimikian et al. The results of these studies showed that Apgar scores 1 and 5 in the physiological delivery group were better than normal delivery [12, 24].
Due to the fact that in physiological childbirth, the least interventions are made on the mother, and on the other hand, due to the reduction of unnecessary interventions, the mother's hormonal system is balanced and the adrenaline level is at the lowest level, resulting in reduced fear and anxiety. The consequences of infancy can and should be expected to be better for mothers who give birth physiologically than for mothers who give birth naturally.

 

The results showed that at 6 hours postpartum, the mean of hemoglobin and hematocrit in the physiological delivery group was significantly higher than conventional vaginal delivery (P<0.001). Comparison of neonatal Apgar scores of the two groups in minute 1 and minute 5 also showed that the amount of Apgar score in physiological delivery group was higher than conventional vaginal delivery (P<0.05).

 

The present study is the result of the faculty research project with ethics code IR.UMSHA.REC.1397.39 and design code (970218782), approved by the Vice Chancellor for Research and Technology of Hamadan University of Medical Sciences. We would like to thank the esteemed staff of Fatemieh Hospital and the mothers who participated in the project, as well as the Deputy of Research and Technology of Hamadan Medical Sciences, who helped us in the implementation of the project.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.