Materials and Methods
We performed a retrospective cohort study, which included all live,
vertex, term vaginal deliveries (defined as 37-42 weeks of gestation) in
a single large tertiary center between January 2006 and December
2018. We excluded stillbirths, cesarean deliveries (CD), vacuum assisted
vaginal deliveries (VAVD), multifetal gestations, home deliveries,
non-vertex deliveries, vaginal deliveries following more than two
previous CD and deliveries by non- CNMs.
Anonymized patient data were extracted from the real time electronic
computerized medical record (EMR) that is continuously updated during
labor and delivery by certified midwives and obstetricians. Trained
medical secretaries further validate the data before it is entered into
the database. The EMR includes demographic characteristics, medical and
obstetrical history, and data regarding the course of labor and
delivery.