Original articles
Intrapartum care for preventing perineal lacerations in hospitals
2024 Volume 38 Issue 1 Pages 59-69
Details
2024 Volume 38 Issue 1 Pages 59-69
Purpose
To identify midwifery practices during childbirth that help prevent perineal lacerations in hospitals, and how these differ according to the level of experience in newborn delivery assistance.
Methods
A self-administered, unmarked questionnaire was distributed to 202 midwives working in hospital obstetric wards in the Tokyo metropolitan area and having experience assisting in deliveries. The main questions asked were about the frequency of information collection and support offered during birth that help prevent perineal laceration. Descriptive statistics were calculated, and the midwives were divided into groups with less than 200 cases of delivery assistance and more than 200 cases of delivery assistance based on the median. Comparisons were made based on the number of experiences of delivery assistance using the Mann-Whitney's U test. This study was conducted with the approval of the Research Ethics Committee at Yokohama City University (Approval No.: F221000005).
Results
A total of 100 valid completed questionnaires were analyzed (50.5% response rate, 98.0% valid response rate). The types of information gathered most frequently (“always” or “sometimes” by more than 90% of midwives) were “whether the baby is a first birth or a multiparous birth” and “estimated weight of the baby.” In terms of support, the most frequent (“always”) practices were “perineal protection” (88.0%), while the less frequent ones were applying a “perineal warm pack” and “bathing in the first stage of labor.” Furthermore, midwives who had assisted in more than 200 deliveries were significantly more likely than midwives who had assisted in fewer than 200 deliveries to collect information on obstacles to perineal extension, such as previous episiotomy or perineal laceration, and to provide support that did not interfere with natural perineal extension, such as “a voice that does not require excessive effort” and “not touching the perineum too much.”
Conclusion
Midwives with more experience in assisting deliveries provided support based on what they learned experientially. The study suggested the need to facilitate the transfer of assessments and supports from experienced midwives to novices, to raise the standard of midwifery practices.
