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What are the views of midwives in relation to perineal repair?
Hannah G Dahlen1, Caroline S E Homer
1Centre for Midwifery Child and Family Health, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Clinical Midwifery Consultant Sydney South Western Area Health Service, Sydney, Australia. hannahdahlen@optusnet.com.au
Purpose:
To determine the views of midwives towards perineal repair and the most effective way to teach and support midwives in developing this skill.
Procedure:
A questionnaire was distributed to 111 midwives who attended a 1-day seminar. Information was sought on a range of views relating to perineal repair, including experience, confidence, education and accreditation, attitudes and trends.
Findings:
One hundred and six (96%) questionnaires were returned. All respondents (100%) believed midwives should be taught to undertake perineal repair. The most important reason was to provide continuity of care for women. Experience increased confidence and enjoyment in undertaking perineal repair as well as lessening fears over the impact of suturing on women. Experience did not significantly impact on concerns regarding legal implications associated with perineal repair. Three quarters of respondents reported that midwifery students should have practical experience of perineal repair. There was strong support for doctors and midwives to undertake perineal repair education together (96%), preferably in a 1-day workshop format (56%); for standards to be set by the professional colleges (midwifery and obstetrics) (66%); for midwives and doctors to be accredited as competent before performing perineal repair independently (>90%) and for regular updates in perineal repair (93%). The majority of midwives (73%) felt that they were more likely to suture than 5 years ago, due mainly to a greater appreciation of woman centred care (35%). Over 60% of midwives said they would not suture a first-degree tear more than half of the time and 13% would not suture a second-degree tear more than half of the time. PRINCIPLE CONCLUSION: A desire to provide continuity of care appears to be a major motivator for midwives to learn to undertake perineal repair. There is need for standards to be set for perineal repair to encourage consistency in education. Perineal repair programs that involve midwives and doctors training together have strong support from midwives but it is unclear if doctors would also support this. Further research is needed to support or refute the trend for midwives to not suture some perineal trauma.
