A women-centred exploration of postpartum perineal pain when the perineum is diagnosed as intact: A French Gadamerian research study

BACKGROUND

Postpartum perineal pain is a frequent symptom (90%) with consequences on postnatal health regardless of whether the perineum remains intact. The impact of that pain on both short and long-term health has been studied and literature suggests midwives have a role to play in addressing this issue. However, the determinants of perineal pain when no lesions are identified are under researched and there is little understanding of women's views on this topic.

AIM AND OBJECTIVES

The aim of the study was to gain an understanding of postpartum perineal pain when the perineum is considered to be intact. The objectives were •To gain an understanding of postpartum pain and its consequences on health and well-being •To explore women's views and understanding of perineal pain postpartum •To gain an understanding of the determinants of postpartum perineal pain when no anatomic lesion is diagnosed.

METHODS

A Gadamerian hermeneutic approach was used to achieve a shared understanding of the issue. Participants were recruited from two maternity hospitals in the French area of Vaucluse. All women aged 18 to 45 years old, having given birth vaginally to a single live child and diagnosed with an intact perineum, were invited to participate in face-to-face interviews. Eleven participants were interviewed once, six of whom agreed to a second interview which took place over the telephone due to Covid lockdown.

FINDINGS

The findings identified three major themes 1. Can't honestly call it pain, 2. Reassurance in normality, 3. Managing the unexpected. The use of the word pain to describe perineal sensations in postpartum was questioned by the participants, who used inner resources to deal with these sensations. Fostering self-confidence, having the possibility to explain the sensations and qualifying them as normal were some approaches women usedto manage their postpartum perineal sensations in a positive manner.

Toward improving the World Health Organization fifth moment for hand hygiene in the prevention of cross-infection

BACKGROUND

The World Health Organization describes that there are 5 moments during a health care encounter when hand hygiene should be performed. This research explores a number of explanatory hypotheses to inform future intervention development with regard to improving compliance with the fifth moment.

METHODS

A sequential, mixed-methods study was conducted using nonparticipant observation and a survey with focus groups informing the development of the questionnaire. A total of 484 participants were observed and 410 returned a postobservation questionnaire; a response rate of 85%. Analysis explored the role of organizational culture, professional culture/practice, and individual-level variables in explaining compliance with the fifth moment.

RESULTS

Ninety-three percent of participants performed hand hygiene following the fifth moment. Compliance varied between regions, but not by professional group. More than 65% indicated that the fifth moment was clearly defined, achievable, valuable, encouraged, and widely known. However, 60% suggested that it was repetitive. There was a positive relationship between the performance of hand hygiene following the fifth moment and the perception that it was widely known.

CONCLUSIONS

Interventions to improve compliance with the fifth moment should focus on promoting awareness of the fifth moment and how it should be implemented in practice. Mechanisms for raising awareness should include education and role modeling.