Delivery Practices and Perineal Tears: Midwives’ Experiences
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Objective: The aim of this study is to explore the experiences and views of midwives regarding third- and fourth-degree perineal tears. Method: Focus group interviews with midwives from a university hospital. Qualitative analysis using principles from ‘grounded theory’. Findings: The participants mentioned several factors that they considered important for the prevention of tears that may cause injury to the anal sphincter. A crucial aspect was the way in which the midwife deals with the physiological birth process. Amongst the challenges highlighted was the need to pay attention to both the baby’s condition and the mother’s perineum simultaneously, as well as the control of speed during the crowning of the head. One opinion was that tears most often occurred during the delivery of the shoulders, and were not linked merely to crowning. The importance of patience during this phase of the delivery was emphasised. Other essential factors were mentioned, such as teamwork, an environment that stimulated and encouraged midwives to reflect on their actions, professional development, and particularly the importance of practical knowledge. This presupposes firm leadership for the promotion of research and development. Conclusion: In order to prevent perineal tears, we must recognise the complexity of the challenges we face. Research and development in this field must therefore focus, not only on technical aspects, but also on teamwork, social setting, interpersonal relations and midwives’ reflections on their own practice.
This article is a translated version of the Norwegian article published in "Vård i Norden" - 2007 no.84 vol 127 p.9-13