Protecting the perineum: midwifery expertise

A recent study has added to our knowledge about the views and skills of midwives who have expertise in protecting women’s perineums during birth. The research, known as the ‘MEPPI study’ is described as a qualitative exploratory study and the researchers interviewed 21 midwives from Ireland and New Zealand who were considered to be expert in preserving the perineum intact.

The results? “Four themes were identified; ‘Sources of knowledge for PPI’, ‘Associated factors’, ‘Decision-making on episiotomy’, and ‘Preparations for PPI’. Participants drew heavily on multiple sources of knowledge in building their own expertise for PPI. Physical characteristics of the perineum featured prominently as factors leading to PPI. Episiotomy was, in the main, only performed when there were signs of fetal distress. Antenatal perineal massage was supported.” (Smith et al 2017)

A couple of findings that are interesting are that several of the midwives in this study mentioned that they didn’t think birthing in water was protective of the perineum, and that they thought the shape of the perineum was more important as a predictive factor than the size of the baby. If you’re interested in this area though, do go and read the paper in full, as it contains so much that is worthy of discussion.

This is a topic that is distressing many women, midwives and birth folk at the moment, as some employed midwives find themselves being coerced into adopting routines and procedures which they do not believe to be the most effective or the best for the women in their care. Women who are birthing within systems of maternity care find themselves subject to these manoeuvres, often without being asked for consent or offered alternatives. In the meantime, studies such as the MEPPI study, along with plenty of other data, such as that gained from study of the Albany Midwifery Practice outcomes are showing that there are other ways, and that the outcomes may be better. The midwives in the MEPPI study also had very low rates of 3rd and 4th degree tears, so it is clear from a number of courses that rigid procedures are not the only means to this end. (If they are a means … many people would argue that we still don’t have good data on that). Clearly, we need to keep researching, and to not forget the value of midwifery experience, expertise and wisdom.

 

The Research

Objectives: Perineal trauma during birth can result in short or long term morbidity for women. Internationally, rates of episiotomy and severe perineal tears vary considerably. In New Zealand, in 2011, and in a trial of midwife-led care in Ireland, episiotomy rates were found to be considerably lower than those in many other countries. A qualitative exploratory study was undertaken to ascertain how midwives achieve these low rates, in these countries and settings.

Design and Participants: A qualitative exploratory study was conducted. Midwives expert in preserving the perineum intact (PPI) from two maternity units in the Republic of Ireland and from varied birth settings in New Zealand, were eligible to participate. Twenty-one consenting midwives took part, seven from Ireland and 14 from New Zealand.

Methods: University ethical approval was granted. Face-to-face, semi-structured interviews were used to collect the data. Interviews were recorded and transcribed verbatim. The data were analysed using Ethnograph software and were organised into prominent themes.

Findings: Four themes were identified; ‘Sources of knowledge for PPI’, ‘Associated factors’, ‘Decision-making on episiotomy’, and ‘Preparations for PPI’. Participants drew heavily on multiple sources of knowledge in building their own expertise for PPI. Physical characteristics of the perineum featured prominently as factors leading to PPI. Episiotomy was, in the main, only performed when there were signs of fetal distress. Antenatal perineal massage was supported.

Conclusion: This study provides valuable insight into the views and skills of midwives, with expertise in PPI at birth, adding to the body of evidence on this topic.

Smith V, Guilliland K, Dixon L et al (2017). Irish and New Zealand Midwives’ expertise at preserving the perineum intact (the MEPPI study): perspectives on preparations for birth. Midwifery 55: 83-89. DOI: http://dx.doi.org/10.1016/j.midw.2017.09.011
photo credit: oneroadlucky pretty pink via photopin (license)

2 comments for “Protecting the perineum: midwifery expertise

  1. Alison Brown
    October 23, 2017 at 9:46 am

    Thankyou for sharing this! How can I obtain a PDF of the full article please?

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