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

02 January 2019
Volume 27 · Issue 1



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.


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


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


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.


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).

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