Association Between Perineal Trauma and the Characteristics of Clinicians Providing Birth Care-A Scoping Review

Perineal trauma remains a common outcome of spontaneous vaginal birth, often leading to immediate and long-term complications. Although numerous studies have examined clinical factors, the influence of individual clinician characteristics-such as professional role, experience, training, and attitudes-has received less attention.

This scoping review synthesized existing evidence on the association between clinician characteristics and variations in perineal outcomes including obstetric anal sphincter injury, episiotomy, spontaneous tears and intact perineum. The review also examined methods of risk assessment and strategies to mitigate trauma related to clinician factors.

The review was conducted following Joanna Briggs Institute methodology to map the breadth of evidence in this field.

A systematic search was undertaken across multiple electronic databases using predefined keywords and inclusion criteria. Sixty-two studies, published between 1969 and 2024 from 25 countries, were included. Study designs encompassed cohort, cross-sectional, randomized controlled trials, qualitative and mixed methods.

Episiotomy was the primary outcome in 57 studies, while 27 studies focused on obstetric anal sphincter injury and 10 on intact perineum. Clinician factors, particularly professional role, attitudes, experience and education, were consistently associated with variations in perineal outcomes. Midwifery-led care frequently corresponded with lower episiotomy rates, although it was sometimes linked with similar or slightly higher spontaneous tear rates.

Reducing perineal trauma requires addressing both fixed and modifiable clinician factors. Standardized episiotomy training, adherence to evidence-based guidelines and collaborative, woman-centered care are recommended strategies to enhance the quality of maternity care for improved patient outcomes.