A qualitative study to explore UK midwives' individual practice, beliefs and attitudes regarding perineal care at the time of birth

Background: Perineal protection at the time of birth by midwives is a topical issue, particularly with the increase in third- and fourth-degree tears (Gurol- Urganci et al 2013). The rate of increase is different between... [ view full abstract ]

Background: Perineal protection at the time of birth by midwives is a topical issue, particularly with the increase in third- and fourth-degree tears (Gurol- Urganci et al 2013). The rate of increase is different between maternity units and geographical areas across the UK (Carroll et al 2016) and therefore cannot be explained by relevant maternal risk factors alone, such as weight or age. Evidence is accumulating to identify best practice to inform midwives’ knowledge and understanding of reducing perineal tear rates (NICE 2015; Aasheim et al 2011) however, little is known about current midwives’ practice in the UK at the time of birth.

Aim: Explore UK midwives’ practice, beliefs and attitudes regarding perineal care at the time of birth.

Methods: Five focus groups were undertaken across the UK. Midwives were identified through the Supervisors of Midwives network and were working in maternity services which included home, freestanding, alongside and consultant led units. The discussions were digitally recorded, transcribed and anonymised before being thematically analysed.

Results: Key themes were i) variety and variation in practice; ii) age of midwife; iii) the mentor, student relationship; iv) unseen practice and v) the midwife’s shame.

Discussion: All groups identified that there was variation in perineal practice which was not always evidence-based. Age of the midwife was seen as a relevant factor and the mentor / student relationship had an impact on what students learnt and how they practiced in the future. Midwives expressed they often did not know the practice of their colleagues as much of it went on behind closed doors. Finally midwives expressed feeling ashamed and responsible for severe tears.

Conclusion: The findings are a valuable and timely addition to the debate regarding perineal practice. Knowledge of the current beliefs and attitudes of midwives will be important prior to implementing the RCOG / RCM intervention package regarding perineal protection (RCOG 2017).

Ethics approval: Granted by the local university

Funding: Wellbeing of Women Charity

Results: Will be presented at Conference.

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References:

Aasheim, V., Nilsen. A., Lukasse. M., Reinar. L. 2011. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane. http://www.cochrane.org/CD0066... accessed 13.4.17

Carroll F, Knight H, Cromwell DA, Gurol Urganci I, van der Meulen J. 2016. Patterns of maternity care in English NHS trusts 2013/2014; 2016

National Institute for Health Care Excellence. 2015. Intrapartum care for healthy women and babies. https://www.nice.org.uk/guidan... (CG 190)

Gurol-Urganci. G., Cromwell. D.A., Edozien. L.C., Mahmood. T.A., Adams. E.J., Richmond. D.H., Templeton. A., Van der Meulen. J.H. 2013. Third and Fourth degree perineal tears among primparous women in England between 2000 and 2012: time trends and risk factors. British Journal of Obstetrics and Gynaecology. http://onlinelibrary.wiley.com... .

Royal College of Obstetricians and Gynaecologists. 2017. The OASI Care Bundle Project. https://www.rcog.org.uk/en/gui...