Perineal trauma: reducing associated postnatal maternal morbidity

Perineal tears affect about 85% of women undergoing normal delivery in the UK. The proper understanding of perineal anatomy by midwives and trainee doctors is important for the correct recognition of the severity of tears. Measures to minimise perineal tears include teaching pelvic floor exercise during the third trimester, psychological support during labour and good perineal support during the second stage of labour. To ensure good management, systematic examination of the perineum, vagina, and rectum should be done under good light for all vaginal deliveries. Proper recognition of the degree of tears, selection of suture materials and seeking senior help whenever needed are crucial. Of those women who prefer elective caesarean section rather than vaginal delivery, 80% do so because of the fear of perineal damages. These adverse outcomes can be minimised by training midwives and trainee doctors with surgical skills workshops in the use of models, audiovisual aids, case scenarios and perineal repair simulation exercises.