Midwives’ and doctors’ perceptions of their preparation for and practice in managing the perineum in the second stage of labour: a cross-sectional survey

East, Christine E., Lau, Rosalind and Biro, Mary Anne (2014) Midwives’ and doctors’ perceptions of their preparation for and practice in managing the perineum in the second stage of labour: a cross-sectional survey. Midwifery, 31 1: 122-131. doi:10.1016/j.midw.2014.07.002

Author East, Christine E.
Lau, Rosalind
Biro, Mary Anne
Title Midwives’ and doctors’ perceptions of their preparation for and practice in managing the perineum in the second stage of labour: a cross-sectional survey
Journal name Midwifery   Check publisher's open access policy
ISSN 0266-6138
Publication date 2014-07-15
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.midw.2014.07.002
Open Access Status
Volume 31
Issue 1
Start page 122
End page 131
Total pages 10
Place of publication London, United Kingdom
Publisher Churchill Livingstone
Collection year 2015
Language eng
Formatted abstract
Objective: to identify the perceptions of midwives and doctors at Monash Women׳s regarding their educational preparation and practices used for perineal management during the second stage of labour.
Design:anonymous cross-sectional semi-structured questionnaire (‘The survey’).
Setting: the three maternity hospitals that form Monash Women׳s Maternity Services, Monash Health, Victoria, Australia.
Participants:midwives and doctors attending births at one or more of the three Monash Women׳s maternity hospitals.
Methods: a semi-structured questionnaire was developed, drawing on key concepts from experts and peer-reviewed literature.
Findings: surveys were returned by 17 doctors and 69 midwives (37% response rate, from the 230 surveys sent). Midwives and doctors described a number of techniques they would use to reduce the risk of perineal trauma, for example, hands on the fetal head/perineum (11.8% of doctors, 61% of midwives), the use of warm compresses (45% of midwives) and maternal education and guidance with pushing (49.3% of midwives). When presented with a series of specific obstetric situations, respondents indicated that they would variably practice hands on the perineum during second stage labour, hands off and episiotomy. The majority of respondents indicated that they agreed or strongly agreed that an episiotomy should sometimes be performed (midwives 97%, doctors 100%). All the doctors had training in diagnosing severe perineal trauma involving anal sphincter injury (ASI), with 77% noting that they felt very confident with this. By contrast, 71% of the midwives reported that they had received training in diagnosing ASI and only 16% of these reported that they were very confident in this diagnosis. All doctors were trained in perineal repair, compared with 65% of midwives. Doctors were more likely to indicate that they were very confident in perineal repair (88%) than the midwives (44%). Most respondents were not familiar with the rates of perineal trauma either within their workplace or across Australia.
Key conclusions: Midwives and doctors indicated that they would use the hands on or hands off approach or episiotomy depending on the specific clinical scenario and described a range of techniques that they would use in their overall approach to minimising perineal trauma during birth. Midwives were more likely than doctors to indicate their lack of training and/or confidence in conducting perineal repair and diagnosing ASI.
Implications for practice: many midwives indicated that they had not received training in diagnosing ASI, perineal repair and midwives׳ and doctor׳s knowledge of the prevalence of perineal outcomes was poor. Given the importance of these skills to women cared for by midwives and doctors, the findings may be used to inform the development of quality improvement activities, including training programs and opportunities for gaining experience and expertise with perineal management. The use of episiotomy and hands on/hands off the perineum in the survey scenarios provides reassurance that doctors and midwives take a number of factors into account in their clinical practice, rather than a preference for one or more interventions over others.
Keyword Midwives
Anal sphincter injury
Perineal management
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article in Press

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
School of Nursing, Midwifery and Social Work Publications
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Citation counts: TR Web of Science Citation Count  Cited 5 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 4 times in Scopus Article | Citations
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Created: Mon, 28 Jul 2014, 13:50:43 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work