The Length of the Active Phase of the Second Stage of Labour in Women Giving Birth in Greenland Compared to Denmark: a pilot study

Objective: Midwives in Greenland observe that people give birth faster, with fewer complications tentatively due to early maternal expulsive efforts in second stage. Our aim was to quantify these observations and potential geographical differences. Design: Bicentre observational prospective cohort study. Method: Between October and December 2020, 50 participants in labour in Aabenraa (Denmark) and Nuuk (Greenland) participated. Transperineal head-perineum distance was measured with a handheld ultrasound scanner. Negative binomial regression was used to calculate incidence rate ratio. Fetomaternal outcome was recorded and compared Results: The median duration of maternal expulsive efforts was 23 minutes in Denmark compared to 10 minutes in Greenland (p=0.046). This was adjusted for parity, epidural use and gestational age. In Denmark 22 % and in Greenland 81 % started maternal expulsive efforts before the fetal head was at the pelvic floor (p-value< 0.001). Conclusion: Although the duration of maternal expulsive efforts and head-perineum distance was significantly different in the univariate analysis, in the multivariate analysis this was not affected by ethnicity. There was no significant difference in bleeding, perineal tears, or Apgar scores. There is a tendency of a shorter duration of maternal expulsive efforts in the active phase of the second stage of labour distance in Greenland compared to practice in Denmark. However, it seems that epidural and parity could be the main confounders to explain the difference between the two groups, but this needs further investigation.