Expert midwives and perineal care during birth

A study published in Women and Birth has offered further insight into the knowledge and skills used by expert midwives in keeping women’s perineums intact during birth. Led by Cecily Begley, the researchers interviewed midwives in New Zealand and Ireland in order to explore what might lie behind their low rates of perineal trauma (Begley et al 2018).

This kind of research is so valuable, because the richness of the data can help us to understand and explore the issues in more depth than when we only have quantitative data relating to a population of women. The findings give us some clues as to why women who birth with a midwife may have a higher chance of an intact perineum, and they may also help explain differences between the outcomes seen in different environments of care.

Here’s a summary of the study (Begley et al 2018), but I wholeheartedly recommend reading the entire paper if you can get hold of it.


The Research:

Background: 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.

Aim: To explore expert Irish and New Zealand midwives’ views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth.

Methods: 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.

Results: 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.

Conclusions: 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.


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Begley C, Guilliland K, Dixon L et al (2018). A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women and Birth, in press,
Photo by Kyle Myburgh on Unsplash