School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
New Zealand College of Midwives, Christchurch, New Zealand.
Women Birth. 2019 Feb;32(1):87-97. doi: 10.1016/j.wombi.2018.04.015. Epub 2018 May 3.
The perineum stretches during birth to allow passage of the baby, but 85% of women sustain some degree of perineal trauma during childbirth, which is painful post-partum. Episiotomy rates vary significantly, with some countries having rates of >60%. Recent Irish and New Zealand studies showed lower severe perineal trauma and episiotomy rates than other countries.
To explore expert Irish and New Zealand midwives' views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth.
Following ethical approval a qualitative, descriptive study was undertaken. Semi-structured, recorded, interviews were transcribed and analysed using the constant comparative method. Expert midwives employed in New Zealand and one setting in Ireland, were invited to join the study. "Expert" was defined as achieving, in the preceding 3.5 years, an episiotomy rate for nulliparous women of <11.8%, a 'no suture' rate of 40% or greater, and a severe perineal tear rate of <3.2%. Twenty-one midwives consented to join the study.
Four core themes emerged: 'Calm, controlled birth', 'Position and techniques in early second stage', 'Hands on or off?' and 'Slow, blow and breathe the baby out.' Using the techniques described enabled these midwives to achieve rates, in nulliparous women, of 3.91% for episiotomy, 59.24% for 'no sutures', and 1.08% for serious lacerations.
This study provides further understanding of the techniques used by expert midwives at birth. These findings, combined with existing quantitative research, increases the evidence on how to preserve the perineum intact during spontaneous birth.
会阴在分娩时会伸展，以允许婴儿通过，但 85%的女性在分娩时会遭受不同程度的会阴创伤，产后会感到疼痛。会阴切开术的发生率差异很大，有些国家的发生率>60%。最近爱尔兰和新西兰的研究显示，严重会阴创伤和会阴切开术的发生率低于其他国家。
探讨爱尔兰和新西兰的专家助产士在自然阴道分娩中保持会阴完整所采用的技能。
在获得伦理批准后，进行了一项定性描述性研究。对半结构化、记录的访谈进行了转录，并使用恒定比较法进行了分析。邀请在新西兰和爱尔兰的一个地点工作的专家助产士参加这项研究。“专家”的定义是，在过去 3.5 年中，初产妇的会阴切开率<11.8%，无缝线率>40%，严重会阴撕裂率<3.2%。有 21 名助产士同意参加这项研究。
出现了四个核心主题：“平静、控制良好的分娩”、“第二产程早期的姿势和技术”、“手放或不放？”以及“缓慢、吹气、让婴儿自然娩出。”使用描述的技术使这些助产士能够在初产妇中达到 3.91%的会阴切开率、59.24%的“无缝线”率和 1.08%的严重撕裂率。
这项研究进一步了解了专家助产士在分娩时使用的技术。这些发现，结合现有的定量研究，增加了关于如何在自然分娩中保持会阴完整的证据。
