Hands-on during the expulsive period: hero or villain?

Abstract

BACKGROUND: Despite all the advances in health sciences, the approach during labor still follows a number of controversial and little consensus based on evidence, among which techniques with or without the use of hands during expulsion, respectively hands- on and hands-off, have gained prominence in the literature, but still lack in consensus. AIMS: to investigate whether the use of the hands-on technique, as opposed to the hands-off, is indeed beneficial to parturient women. METHOD: Systematic review, in Pubmed, BVS, PEDro and Scielo databases, using the keywords birth, hands-on and hands-off isolated or combined, as well as its variants in Portuguese. Data were organized by technique, measurement instrument and results. RESULTS: Of the 14 studies that comprised the present review, only three were controlled trials. Six studies pointed to the occurrence of less injuries when the hands-on technique was used, but in all controlled studies, there was no statistically significant difference between the results of the groups was low. CONCLUSION: The hands-on technique has been used around the world, but there is not enough evidence that it actually prevents any type of obstetric injury. Despite the existence of controlled trials, the contrast of the results regarding the laceration between the control and test groups is not strong enough for more solid conclusions.