Perceptions of Perineal Repair: A Study to explore women’s perceptions of perineal repair as an aspect of normal childbirth.

Aims and objectives

The purpose of this study is to explore women’s perceptions of perineal repair as an aspect of normal childbirth. The objectives were: to determine the importance women place on this part of the childbirth experience; to determine whether women understand the degree of trauma sustained; to investigate if women feel informed about the level of repair undertaken; and to explore the impact suturing has on the transition to motherhood. The final objective was to ascertain whether women’s experiences differ from antenatal expectations and to see if there are any aspects of repair that could be improved upon, to address a woman’s psychological needs.

Design

The study design was qualitative and utilised interpretive phenomenology. The data was collected during a one-off in-depth interview which took place within one month of birth. Prompt questions were used but the flow of the interviews was spontaneous and participant led. The prompt questions were adapted throughout the course of the study to reflect emergent categories. With the informed consent of the participants, the interviews were recorded and notes taken during interviews. The interviews were then transcribed and analysed using thematic content analysis. The transcripts were coded to form categories and then further analysed to form themes.

Setting

This was a single setting study, based in an NHS Trust in The East Midlands of England. The birth centre has an approximate birth rate of 3000 per year. The birth centre is divided into two parts; the consultant led area for women with complex needs for pregnancy and birth and the midwife-led area which is aimed to promote normality and active birth.

Participants

11 women were recruited for this study. All of the women were aged between 18 and 34 years old and were invited to participate postnatally by their community midwives. All were nulliparous prior to birth and had received no obstetric intervention during their birth experience. 10 of the sample had sustained a 2nd degree tear, and one had a tear to the posterior vaginal wall. Three of the group also had labial lacerations which required suturing. All of the suturing was undertaken by midwives.

Findings

Nine categories were initially developed and then further analysed. This resulted in three emergent themes. These were entitled; the mystery of perineal repair, perineal repair and the transition to motherhood, and midwife facilitated repair a completely “normal” experience.

Conclusion

This study found that women are accepting of perineal trauma and repair as an aspect of normal birth, when it is managed correctly. Women’s satisfaction with the process is significantly improved when they are given sufficient information to be able to understand and rationalise their tear. Women place as much significance on the lead up antenatally and their recovery afterwards as they do to physically being sutured. Current antenatal services fail to inform women about the intricacies of perineal trauma and repair, and women frequently utilise friends and relatives to shape their antenatal preconceptions. The transition to motherhood for women who feel fully informed about their trauma is smoother. Those who feel they have unresolved questions tend to complain of more pain, make unnecessary physiological adaptations and rely more upon their partners. This study also highlighted that some midwives display a lack of confidence in diagnosing trauma and undertaking perineal repair.