References

Arias T, Coxon K. An experiential model of education introduced to improve the confidence of student midwives undertaking second stage management of the perineum (SSMP). Midwifery. 2018; 59:144-8 https://doi.org/10.1016/j.midw.2018.01.014

Berger R. Now I see it, now I don't: researcher's position and reflexivity in qualitative research. Qualitative Research. 15:(2)219-34 https://doi.org/10.1177%2F1468794112468475

Bick D, Ismail K, Macdonald S, Thomas P, Tohill S, Kettle C. How good are we at implementing evidence to support the management of birth-related perineal trauma? A UK-wide survey of midwifery practice. BMC Pregnancy and Childbirth. 2012; 12 https://doi.org/10.1186/1471-2393-12–57

Briscoe L, Lavender T, O'Brien E, Campbell M, McGowan L. A mixed methods study to explore women and clinician's response to pain associated with suturing second degree perineal tears and episiotomies [PRAISE]. Midwifery. 2015; 31:(4)464-72 https://doi.org/10.1016/j.midw.2014.12.010

Campbell F. ‘Can you tell me about your perineal suturing career?’ Midwives' experiences of perineal suturing accreditation: a descriptive study. MIDIRS Midwifery Digest. 2016; 26:(3)327-33

Clements V, Davis D, Fenwick J. Continuity of care: supporting new graduates to grow into confident practitioners. International Journal of Childbirth. 2013; 3:(1)3-12

Dahlen HG, Homer CSE. What are the views of midwives in relation to perineal repair?. Women Birth. 2008; 21:(1)27-35 https://doi.org/10.1016/j.wombi.2007.12.003

East C, Sherburn M, Nage C, Said J, Forster D. Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2012; 28:(1)93-7 https://doi.org/10.1016/j.midw.2010.11.009

Flick U. An introduction to qualitative research, 5th edn. London: SAGE Publications; 2014

Hobbs JA. Newly-qualified midwives' transition to qualified status and role: assimilating the ‘habitus’ or reshaping it?. Midwifery. 2012; 28:(3)391-9 https://doi.org/10.1016/j.midw.2011.04.007

Hunter B. Conflicting ideologies as a source of emotion work in midwifery. Midwifery. 2004; 20:(3)261-72 https://doi.org/10.1016/j.midw.2003.12.004

Ismail KMK, Kettle C, Macdonald SE, Tohill S, Thomas PW, Bick D. Perineal assessment and repair longi-tudinal study (PEARLS): a matched-pair cluster randomized trial. BMC Med. 2013; 11 https://doi.org/10.1186/1741-7015-11-209

Keighley T. European Union standards for nursing and midwifery: information for accession countries, 2nd edn. Copenhagen: WHO; 2009

Kettle C, Hills RK, Jones P, Darbya L, Gray R, Johanson R. Continuous versus interrupted perineal repair with standard or rapidly absorbed sutures after spontaneous vaginal birth: a randomised controlled trial. Lancet. 2002; 359:(9325)2217-23 https://doi.org/10.1016/S0140-6736(02)09312-1

Postnatal care up to 8 weeks after birth [CG37].London: NICE; 2015

NMC Circular 21/2006: preceptorship guidelines.London: NMC; 2006

Standards for pre-registration midwifery education.London: NMC; 2009

Reiger K. Domination or mutual recognition? Professional subjectivity in midwifery and obstetrics. Social Theory & Health. 2008; 6:132-47 https://doi.org/10.1057/palgrave.sth.2007.12

Salmon D. A feminist analysis of women's experiences of perineal trauma in the immediate postnatal period. Midwifery. 1999; 15:(4)247-56 https://doi.org/10.1054/midw.1999.0182

Selo-Ojeme D, Pathak S, Joshi V. The knowledge, practice and opinion of midwives in the UK on their training in obstetric perineal repair. Arch Gynecol Obstet. 2015; 291:(6)1265-70 https://doi.org/10.1007/s00404-014-3574-0

Smith J, Flowers P, Larkin M. Interpretative Phenomenological Analysis: Theory, Method and Research.London: SAGE Publications; 2009

Smythe E. From beginning to end: how to do hermeneutic interpretive phenomenology. In: Thomson G, Dykes F, Downe S (eds). Abingdon: Routledge; 2011

Thiagamoorthy G, Johnson A, Thakar R National survey of perineal trauma and its subsequent management in the United Kingdom. Int Urogynecol J. 2014; 25:(12)1621-7 https://doi.org/10.1007/s00192-014-2406-x

Wilson AE. Effectiveness of an educational programme in perineal repair for midwives. Midwifery. 2012; 28:(2)236-46 https://doi.org/10.1016/j.midw.2011.02.011

Young N. An exploration of clinical decision-making among students and newly-qualified midwives. Midwifery. 2012; 28:(6)824-30 https://doi.org/10.1016/j.midw.2011.09.012

Early-career midwives' experiences of perineal assessment and repair after normal vaginal birth

02 January 2019
12 min read
Volume 27 · Issue 1

Abstract

Background

It falls within the midwife's scope of practice to assess and repair first- and second-degree perineal trauma. Failure to accurately do so can lead to significant maternal morbidities. Evidence suggests that this can be a source of anxiety for midwives.

Aims

To explore early-career midwives' experiences of performing perineal assessment and repair after normal vaginal birth.

Methods

A qualitative semi-structured interview study analysed via interpretative phenomenological analysis. Six purposively-selected midwives, qualified for fewer than 5 years, were interviewed.

Findings

The study identified two superordinate themes. ‘Working and learning in an imperfect environment’ highlighted inadequacies in pre-registration midwifery education in preparing midwives for suturing, and a lack of support for developing their clinical skills once qualified. ‘Knowing myself, understanding my women’, highlighted midwives' understanding of suturing in terms of professional identity, responsibility for women's wellbeing and promotion of continuity.

Conclusions

Midwives often experience their pre-registration training as poor preparation for suturing in practice. Once qualified, preceptorship programmes can be variable and support for skills development is often lacking. Time constraints and structural hierarchies can inhibit the ability of midwives to articulate and advance their learning needs.

It is estimated that approximately 350 000 women in the UK will experience some degree of perineal trauma during childbirth, and 75% of these will require suturing (Kettle et al, 2002; Thiagamoorthy et al, 2014). Failure to accurately assess and repair perineal trauma can result in significant maternal morbidities including pain, infection, dyspareunia and incontinence. Women may also report psychological sequelae (Salmon, 1999; East et al, 2012).

Skilled repair of first- or second-degree perineal trauma is considered a core midwifery competency and it is imperative that midwives can undertake this accurately, to reduce adverse outcomes (National Institute for Health and Care Excellence (NICE), 2015). Research suggests, however, that many midwives lack confidence in this skill, claiming dissatisfaction with their level of training, experience or support in perineal assessment and repair (Selo-Ojeme et al, 2015; Campbell, 2016).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month