Patient and Provider Attitudes Toward Perineal Injury Prevention Techniques for Vaginal Birth: A Qualitative Study

To understand the motivations and barriers associated with engaging in perineal trauma-reducing interventions for childbirth, including antenatal perineal massage, warm compress use, and selective episiotomy.

In this qualitative study, we recruited patients at more than 34⁰ weeks' gestation who were planning a vaginal birth, as well as maternity care providers. Semi-structured, one-on-one interviews were conducted until data saturation was achieved. A constructivist approach to thematic analysis was used to analyze the interviews. A coding framework was developed following independent review of a subset of interviews and was subsequently used to code the data and generate themes.

Fifteen patients and 10 providers were included in the analysis. Motivators for adopting perineal protection strategies included perceived ease of recovery, fear of perineal injury, body awareness, personal experience, and provider and community guidance. Barriers to the use of common methods to reduce the risk of tearing were classified into three major themes: psychological, physical, and social. Psychological subthemes included fear, knowledge (including beliefs regarding minimal benefit), mental barriers, and motivational disengagement. Physical subthemes included structural access, physical discomfort, time constraints, and resource limitations. Social subthemes included autonomy, provider distrust, communication challenges, and cultural taboo. Episiotomy was identified as a controversial intervention by both providers and patients because of concerns regarding respect for patient autonomy.

Provider guidance was a key motivator for the adoption of techniques aimed at reducing perineal trauma during vaginal birth. Future strategies to prevent perineal trauma at vaginal birth should focus on addressing common barriers to participation in low-risk interventions.