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Rodrigues S, Silva P, Vieira R, Duarte A, Escuriet R. Midwives' practices on perineal protection and episiotomy decision-making: A qualitative and descriptive study. Eur J Midwifery 2024; 8:EJM-8-19. [PMID: 38736456 PMCID: PMC11082654 DOI: 10.18332/ejm/174126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 10/09/2023] [Accepted: 11/23/2023] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Perineal trauma is associated with both short- and long-term morbidity which in turn relates to the degree of trauma. The objective of this study was to understand midwives' practices regarding perineal protection during the second phase of labor, emphasizing decision-making to perform an episiotomy. METHODS A descriptive and explanatory study was conducted with an intentional sample of twenty-two midwives working in the labor ward of a tertiary hospital in a metropolitan location and in the public service, in Portugal. A semi-open interview was applied to collect the data from 5 to 15 January 2019. The computer software package, NVivo version 10, was used to perform the thematic analysis. RESULTS Four main themes arose from the midwives' data: 1) Factors affecting the application of perineal protection techniques', 2) Birth position, 3) Techniques for perineal protection, and 4) Episiotomy. The reasons for performing an episiotomy were the presence of tense perineum, large weight baby, previous obstetric anal sphincter injury, and Kristeller maneuver. CONCLUSIONS Midwives' practices regarding perineal protection techniques and reasons for performing an episiotomy were not all in line with the evidence. Perineal massage was not mentioned as a perineal protection technique.
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Affiliation(s)
- Silvia Rodrigues
- Biomedical Sciences Institute Abel Salazar, Porto, Portugal
- Hospital of Braga, Braga, Portugal
| | | | | | | | - Ramon Escuriet
- Health and Integrated Care division, Catalan Health Service, Barcelona, Spain
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Seijmonsbergen-Schermers AE, Peerdeman KMCM, van den Akker T, Titulaer LML, Roovers JP, Peters LL, Verhoeven CJ, de Jonge A. Differences in rates of severe perineal trauma between midwife-led and obstetrician-led care in the Netherlands: A nationwide cohort study. Heliyon 2024; 10:e24609. [PMID: 38312656 PMCID: PMC10835235 DOI: 10.1016/j.heliyon.2024.e24609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
Objective To investigate trends and rates of severe perineal trauma (SPT), also known as obstetric anal sphincter injury (OASI), between midwife-led and obstetrician-led care in the Netherlands, and factors associated with SPT. Methods This nationwide cohort study included registry data from 2000 to 2019 (n = 2,169,950) of spontaneous vaginal births of term, live, cephalic, single infants, without a (previous) caesarean section or assisted vaginal birth.First, trends of SPT and episiotomy were shown. Second, differences in SPT rates between midwife- and obstetrician-led care were assessed. Third, associations of care factors with SPT were examined. Multivariable logistic regression analyses were used to determine which factors were important in the associations. All outcomes were stratified for parity. Results Over time, the SPT incidence increased mainly in midwife-led care and episiotomy rates decreased. Compared to midwife-led care, SPT rates were lower in obstetrician-led care among primiparous women (aOR 0.78; 99 % CI 0.74-0.81) and comparable among multiparous women (aOR 1.04; 99 % CI 0.99-1.10). Among women without epidural analgesia, these differences were smaller for primiparous women (aOR 0.88; 99 % CI 0.84-0.92), but the SPT rate was higher in obstetrician-led care among multiparous women (aOR 1.09; 99 % CI 1.03-1.15). Among women without shoulder dystocia, induction, augmentation, and pain medication, SPT rates were comparable among primiparous women, but higher among multiparous women in obstetrician-led care. In midwife-led care, SPT occurred more often among hospital versus home births. In obstetrician-led care, lower SPT incidences were found among births with epidural analgesia and for multiparous women with induction or augmentation. Conclusions Iinduction, augmentation, and epidural analgesia in obstetrician-led care may be an explanatory factor for the higher incidence of SPT among primiparous women in midwife-led care. More research is needed to explain differences in SPT rates and to understand how SPT can be prevented, while maintaining a high intact perineum rate.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Kelly MCM. Peerdeman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, Netherlands
| | - Linde ML. Titulaer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Lilian L. Peters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Corine J. Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
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Khalaf A, Al Amri N, Al Qadire M. Childbirth-related episiotomy and tear in relation to risk of postpartum depression: a retrospective cohort study on Omani mothers. J Reprod Infant Psychol 2023:1-14. [PMID: 38153261 DOI: 10.1080/02646838.2023.2300082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/23/2023] [Indexed: 12/29/2023]
Abstract
AIMS/BACKGROUND Studies on the association between perineal trauma (episiotomy and tear) and the risk of postpartum depression in Omani mothers are scarce. This study aimed to screen women for the risk of postpartum depression and associated maternal adverse outcomes (episiotomy and tear) in newly delivered Omani mothers. DESIGN/METHODS Mothers were screened for postpartum depression using only the Edinburgh Postnatal Depression Scale (EPDS), with cut-offs of 1-12 indicating low risk and 13-30 indicating high risk. Data on birth outcomes were collected retrospectively from the medical records. Descriptive analyses, group comparisons, and linear regression analyses were conducted. RESULTS Of the 262 participating mothers (total sample, i.e. mothers with and without depression), 19.0% had an episiotomy, 29.0% had tears, and 52.0% had an intact perineum after their childbirth. The total EPDS score was significantly higher among mothers with episiotomy (10.4, SD = 5.4) compared to those with tears (8.1, SD = 4.8) and those with intact perineum (9.4, SD = 4.9) (p-value <0.05). Lower levels of depression (-2.23 points on average) were significantly (p-value <0.05) associated with higher levels of perineum status (coded as 1 = episiotomy, 2 = other). Mothers who had a tear or episiotomy had on average 1.24 points higher EPDS scores compared to mothers with an intact perineum, although not significant (p-value >0.05). CONCLUSIONS Policymakers and clinicians are recommended to consider following up mothers with adverse birth outcomes to outline the risk of developing postpartum depression, at the same time as they routinely screen all mothers for risk of postpartum depression during their postpartum visits.
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Affiliation(s)
- Atika Khalaf
- The PRO-CARE Group, Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
- Fatima College of Health Sciences, Department of Nursing, Ajman, United Arab Emirates
| | - Nawal Al Amri
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mohammad Al Qadire
- College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
- Faculty of Nursing, Al Al-Bayt University, Mafraq, Jordan
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Rydahl E, Juhl M, Declercq E, Maimburg RD. Disruption of physiological labour; - A population register-based study among nulliparous women at term. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 27:100571. [PMID: 33157403 DOI: 10.1016/j.srhc.2020.100571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 09/11/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Current labour practices have seen an acceleration in interventions to either initiate, monitor, accelerate, or terminate the physiological process of pregnancy and childbirth. This study aimed to describe and analyse the use of interventions in childbirth in Denmark over almost two decades (2000-2017). We also examined the extent to which contemporary care adheres to current international recommendations towards restricted use of interventions. STUDY DESIGN A national retrospective Danish register-based cohort study including all nulliparous women with term births with singleton pregnancy and a foetus in cephalic between the years 2000 and 2017 (n = 380,326 births). Multivariate regression analyses with adjustment for change in population were performed. MAIN OUTCOME MEASURES Induction of labour, epidural analgesia, and augmentation of labour. RESULTS Between 2000/2001 and 2016/2017, the prevalence increased for induction of labour from 5.1% to 22.8%, AOR 4.84, 95% CI [4.61-5.10], epidural analgesia from 10.5% to 34.3% (AOR 4.10, 95% CI [3.95-4.26]), and augmentation of labour decreased slightly from 40.1% to 39.3% (AOR 0.84, 95% CI [0.81-0.86]). Having more than one of the three mentioned interventions increased from 12.8% in to 30.9%. CONCLUSIONS The number of interventions increased during the study period as well as the number of interventions in each woman. As interventions may interfere in physiological labour and carry the risk of potential short- and long-term consequences, the findings call for a careful re-evaluation of contemporary maternity care with a "first, do no harm" perspective.
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Affiliation(s)
- Eva Rydahl
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Mette Juhl
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark
| | - Eugene Declercq
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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