Identifying the factors that influence midwives' perineal practice at the time of birth in the United Kingdom.

Published on Nov 1, 2021in Midwifery2.372
· DOI :10.1016/J.MIDW.2021.103077
Sara L Stride1
Estimated H-index: 1
(BU: Bournemouth University),
Vanora Hundley32
Estimated H-index: 32
+ 1 AuthorsZoe A. Sheppard11
Estimated H-index: 11
OBJECTIVE The Obstetric Anal Sphincter Injuries (OASI) Care Bundle is designed to reduce the incidence of obstetric anal sphincter injuries. However, introducing behavioural change requires an understanding of current practice. This study aims to establish midwives practise at the time of birth, and the factors that influence this. DESIGN Quantitative research - a national online survey. SETTING Nationwide - United Kingdom (UK). Participants 563 midwives from across the UK. METHODS An online survey of midwives' practice. Midwives were invited to participate through the Supervisor of Midwives network. Consent was sought on the landing page. Data analysis using descriptive and inferential statistics, with sub group analyses were used to explore variations in practice. Measurements Number of midwives using "hands on" the perineum and the influences on midwives' perineal practice at the time of birth. FINDINGS Most midwives preferred to use "hands on" the perineum at the time of birth (61.4%). "Hands on" practise was significantly associated with where midwives worked (p<0.001), risk factors for OASI (p<0.001), and the approach that they were taught in their midwifery training (p<0.01). Midwives expressed lack of confidence in some areas with a third unsure that they could identify the third degree tear category b (38.2%) or c (34.3%). KEY CONCLUSIONS There has been a growth in the number of midwives using "hands on" at the time of birth but midwives feel that they require additional training in regards to identifying an OASI. The study should be repeated following the roll out of the OASI care bundle, to identify its impact on midwives' perineal practice. IMPLICATIONS FOR PRACTICE The study identified that there needs to be an improvement in the recognition of OASI by midwives, and in future repeating the study would identify whether the OASI care bundle has influenced midwives' practice.
#1Andrea Woolner (Aberd.: University of Aberdeen)H-Index: 5
#2Dolapo Ayansina (Aberd.: University of Aberdeen)H-Index: 10
Last. Sohinee Bhattacharya (Aberd.: University of Aberdeen)H-Index: 34
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Data Availability: Data cannot be shared publicly because Scottish national registry data was used. Data are available from Information Services Division NHS Services Scotland ( for researchers who meet the criteria for access to confidential data following approval by the Public Benefit and Privacy Panel for Health NHS Scotland (PBPP). The dataset was obtained from the SMR02 maternity data. Funding: This study was funded by a Wellbeing of Women (...
#1Posy Bidwell (Royal College of Obstetricians and Gynaecologists)H-Index: 11
#2Ranee ThakarH-Index: 50
Last. Ipek Gurol-Urganci (Lond: University of London)H-Index: 24
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Third and fourth degree perineal tears, or obstetric anal sphincter injuries (OASI), sustained during childbirth can result in anal incontinence and psychosocial problems which require ongoing treatment. Within the English National Health System (NHS) reported rates of OASI have gradually increased. In response, a care bundle was developed incorporating four elements: 1) antenatal information to women, 2) manual perineal protection during all vaginal births, 3) episiotomy to be performed with a ...
#1Valerie J. Smith (Trinity College, Dublin)H-Index: 67
#2Karen GuillilandH-Index: 7
Last. Cecily Begley (Trinity College, Dublin)H-Index: 52
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Abstract Objectives perineal trauma during birth can result in short or long term morbidity for women. Internationally, rates of episiotomy and severe perineal tears vary considerably. In New Zealand, in 2011, and in a trial of midwife-led care in Ireland, episiotomy rates were found to be considerably lower than those in many other countries. A qualitative exploratory study was undertaken to ascertain how midwives achieve these low rates, in these countries and settings. Design and participants...
#2Adolf Lukanovic (Ljubljana University Medical Centre)H-Index: 6
Last. Miha Lucovnik (Ljubljana University Medical Centre)H-Index: 12
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Abstract Objective to examine potential association between mediolateral episiotomy and reduced incidence of obstetrical anal sphincter injuries (OASIS) diagnosed by endoanal ultrasound. Design prospective cohort study. Setting tertiary referral university hospital. Participants sixty nulliparous women at 28–33 weeks of gestation with singleton pregnancies were included between 2010 and 2012. Measurements and findings participants were examined with endoanal ultrasound at 28–33 weeks gestation a...
#1Vigdis AasheimH-Index: 6
Last. Mirjam Lukasse (HiOA: Oslo and Akershus University College of Applied Sciences)H-Index: 19
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Background Most vaginal births are associated with trauma to the genital tract. The morbidity associated with perineal trauma can be significant, especially when it comes to third- and fourth-degree tears. Different interventions including perineal massage, warm or cold compresses, and perineal management techniques have been used to prevent trauma. This is an update of a Cochrane review that was first published in 2011. Objectives To assess the effect of perineal techniques during the second st...
The Montgomery case in 2015 was a landmark for informed consent in the UK. Two years on, Sarah Chan and colleagues discuss the consequences for practising doctors
#1Pramod R Regmi (BU: Bournemouth University)H-Index: 13
#2Elizabeth Waithaka (BU: Bournemouth University)H-Index: 2
Last. Edwin van Teijlingen (BU: Bournemouth University)H-Index: 55
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Collecting research data through traditional approaches (face-to-face, postal or telephone survey) can be costly and time consuming. The emerging data collection approach based on internet/e-based technologies (e.g. online platforms and email), is a relatively cost effective survey alternative. These novel data collection strategies can collect large amounts of data from participants in a short time frame. Similarly, they also seem to be feasible and effective in collecting data on sensitive iss...
#1Sara S. Webb (University of Birmingham)H-Index: 7
#2D YatesH-Index: 4
Last. Khaled M. K. Ismail (University of Birmingham)H-Index: 24
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Introduction and hypothesis Obstetric anal sphincter injuries (OASIS) are serious complications of vaginal birth. In a pregnancy following OASIS women may be keen to avoid an elective caesarean section, yet cautious about pursuing another vaginal birth that may result in further damage to the pelvic floor and possible long-term anal incontinence. This review aimed to evaluate the impact of subsequent birth and its mode on anal incontinence (AI) and/or quality of life (QoL), for women with previo...
#1Marija Simic (Karolinska University Hospital)H-Index: 6
#2Sven Cnattingius (Karolinska University Hospital)H-Index: 101
Last. Olof Stephansson (Karolinska University Hospital)H-Index: 62
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We sought to investigate the impact of the duration of second stage of labor on risk of severe perineal lacerations (third and fourth degree). This population based cohort study was conducted in the Stockholm/Gotland region, Sweden, 2008–2014. Study population included 52 211 primiparous women undergoing vaginal delivery with cephalic presentation at term. Unconditional logistic regression analysis was used to calculate crude and adjusted odds ratios (OR), using 95% confidence intervals (CI). Ma...
#1Hong Jiang (Fudan University)H-Index: 3
#2Xu Qian (Fudan University)H-Index: 17
Last. Paul Garner (LSTM: Liverpool School of Tropical Medicine)H-Index: 76
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Background Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures. Objectives To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Regis...
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