Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

<p>Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.</p>

Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

<p>Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.</p>

Correction to: One Plus One Equals Two—will that do? A trial protocol for a Swedish multicentre randomised controlled trial to evaluate a clinical practice to reduce severe perineal trauma

An amendment to this paper has been published and can be accessed via the original article.

One Plus One Equals Two—will that do? A trial protocol for a Swedish multicentre randomised controlled trial to evaluate a clinical practice to reduce severe perineal trauma

Background Severe perineal trauma sustained during childbirth is a serious complication since it can lead to both short- and long-term consequences for women. Some of the methods used to prevent perineal injuries have been evaluated in clinical trials, but there are still gaps in the evidence. A new clinical practice has been introduced, adopted by more than half of the maternity wards in Sweden with the aim of reducing severe perineal trauma. This procedure involves two midwives assisting the woman during the second stage of labour. Methods/design In this multicentre randomised controlled trial, 2946 women will be randomised to be assisted by one or two midwives during the second stage of labour. Women age 18–47, who plan for their first vaginal birth, with a singleton pregnancy in cephalic presentation, will be asked to participate when admitted to the maternity ward. Five maternity wards comprising 19,500 births/year in different parts of Sweden will participate in this study. The sample size is powered to demonstrate a 50% reduction (from 4.1–2.0%) in primary outcome, which is the prevalence of severe perineal trauma (3rd and 4th degree). Secondary outcomes will include maternal and neonatal outcomes, women’s experiences, midwives’ experiences of the intervention, incontinence, and pelvic floor symptoms. The primary analysis is intention to treat. Questionnaires will be sent to the women at 1 month and 1 year after the birth to assess women’s experiences, pain, incontinence, pelvic floor symptoms, sexual function, and mental health. Discussion It is important for care during labour and birth to be evidence based. There is a strong desire among midwives to reduce the risk of severe perineal trauma. This may lead to new strategies and practices being implemented into practice without scientific evidence. The intervention might have negative side effects or unintended consequences. On the other hand, there is a possibility of the intervention improving care for women. Trial registration {2a} ClinicalTrials.gov NCT03770962. Registered on 10 December 2018