Birth-Related Perineal Trauma

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Table of Contents

Problem
Recommendations
Implementation
Evaluation
Barriers to Implementation
References

Problem

Perineal trauma is quite common in women giving birth. According to Frohlich and Kettle (2015), perineal trauma is “any injury to the posterior vaginal wall, perineal muscles, or anal sphincter” (p. 2). The instances of perineal traumas are tremendously dangerous for women since they not only cause severe pain but also lead to multiple health complications, which include tears, pelvic floor dysfunction, and postpartum sexual dysfunction (Abedzadeh-Kalahroudi, Talebian, Sadat, & Mesdaghinia, 2019).

However, despite the health complexities that the specified issue entails, the information on the existing care strategies for treating perineal trauma is quite scarce and difficult to obtain for nurses, hence the lack of necessary competencies for tending to the needs of mothers with perineal trauma (Lawrence, Rebecca, Noelle, Dusty, & Clifford, 2016).

Thus, the existing information is indicative of the evident urgency of proper guidelines for managing perineal trauma in women (Zhang et al., 2017). A brochure that would contain concise yet accurate and effective instructions for addressing perineal trauma in midwifery would help to educate nurses about the need to introduce an immediate intervention for women with perineal trauma and offer a quick guide on the strategies that can be adopted to manage perineal trauma adequately.

Recommendations

Since the proposed brochure is expected to improve outcomes of perineal trauma in women, it is advised to incorporate it into midwifery practice by outlining four degrees of perineal trauma (first: injury to skin; second: injury to perineum; third: damage to anal sphincter complex; fourth: damage to anorectal mucosa) (Royal College of Obstetricians and Gynaecologists, 2015). Thus, nurses will be able to assess whether a patient’s condition is critical and whether the lives of the mother and the child are jeopardized in any way.

Moreover, guidelines for addressing the possibility of comorbid problems and the prolonged stay in the hospital with the following threat of developing other health concerns of a nosocomial nature will have to be included in the brochure. The management of nosocomial concerns should be put at the forefront of meeting patients’ needs and alleviating their health issues related to perineal trauma.

The brochure will be intended for midwives and healthcare practitioners that assist a woman during labor. Specifically, the brochure will lay out essential steps for nurses, midwives, and physicians to follow during the labor process to prevent the instance of perineal trauma from occurring or minimize it, as well as the steps for the specified healthcare experts to take if perineal trauma is unavoidable. However, other experts that may assist midwives as a part of an interdisciplinary team may need to read the brochure as well in order to get a general understanding of the foundational requirements for treating perineal trauma.

In order to reduce the effect of perineal trauma on women’s health, the guide will have to include the standards for care set by the World Health Organisation (WHO) in 2018. Specifically, the perineal techniques such as giving the massage, placing a warm compress on the affected area, and guiding should be included in the booklet along with images that detail the specific instructions for applying the suggested methods (World Health Organisation, 2018). Apart from the proposed techniques, medications that will alleviate the pain experienced by patients, along with the treatment opportunities for maintaining the well-being of infants and reducing the threat of perinatal trauma, will be included in the guide.

As an educational resource, the booklet will influence three large categories of stakeholders, which are pregnant women and midwives. The former will receive better care due to the improvements in the guidelines and better cohesion in the actions of nurses who will tend to patients’ needs. The threat of tears will reduce, whereas the quality of postpartum care will increase respectively (Aasheim, Nilsen, Reinar, & Lukasse, 2017). As a result, women giving birth will receive much better midwifery services and avoid developing the health issues that are typically associated with perineal trauma and postpartum health complexities.

Midwives, in turn, will gain a chance at training new skills and gaining a more accurate understanding of the actions that have to be taken to address perineal trauma (Leon-Larios, Corrales-Gutierrez, Casado-Mejía, & Suarez-Serrano, 2017). Specifically, nurses will have a clear set of standards according to which they will act in case of postpartum trauma. As a result, the pressure of decision-making and the threat of choosing the incorrect option when locating the course of actions in addressing perineal trauma will be reduced (Lodge & Haith-Cooper, 2016).

Thus, the threat of workplace burnouts and the extent of emotional stress that midwives experience in the professional setting will drop. Likewise, the problem of errors in the clinical setting and the following health complications observed in patients will also be minimized owing to updated guidelines. Thus, this project will have a lot of importance for midwifery.

Finally, the lives of newborn children will be affected positively by the integration of new instructions into the guidelines for avoiding and managing perineal trauma. Research proves that infants suffer significantly from neonatal traumas occurring during the delivery (Steen & Diaz, 2018). In fact, large trauma may eventually cause the death of an infant (Aguiar et al., 2019). Therefore, by incorporating the techniques that potentially reduce the probability of perineal trauma, midwives will contribute to a drop in infant morbidity rates. Therefore, infants have to be recognized as critical stakeholders of this proposal aimed at reducing the traumatizing effects of perineal tears.

Implementation

The project described above will be put into practice by creating a guide that details assistance to women with perineal traumas of different degrees. WHO’s recommendations for each type of trauma will be incorporated into the guide, with a set of necessary and recommended guidelines for each trauma type. Specifically, the fourth-degree trauma will require the use of the hands-on approach, also known as guards, to ensure that a patient’s well-being remains under control. Fourth-degree perineal traumas, in turn, will imply the application of warm compresses (Floyd, Omar, & Khattak, 2017). The brochure will detail the instructions for creating and applying compresses to the areas that have been affected by perineal trauma.

Evaluation

To determine the value and efficacy of the manual, one will need an assessment of its effects based on its integration in the midwifery setting. For this reason, a case study will be performed to compare the impact of integrating the newly developed standards of care for women with perineal trauma to the records of previous management of the problem in question. The number of positive outcomes that the use of the newly suggested standards will entail will be analyzed and compared to the records of using traditional methods of managing perineal trauma in women. Thus, the efficacy of the new standards of care will be tested. It is expected that the design of clearer and more concise directions for preventing and managing perineal trauma, with specifics of care for each degree of trauma specified, will have a positive effect on the well-being of women.

Barriers to Implementation

Despite the benefits that the creation of the guide provides, several impediments to its integration into the healthcare and midwifery setting are expected to take place when resetting the existing guidelines for perineal trauma. Resistance to change and the unwillingness to alter the traditional course of actions among nurses and midwives is the most expected and by far the most critical problem to address. Nurses may be very reluctant to consider the information in the brochure and, instead, are very likely to succumb to the traditional patterns for managing perineal trauma in the midwifery setting.

To manage the obstacles created by nurses’ reluctance to accept change and learn new skills, one should introduce incentives for complying with the required standards. Penalties for failing to meet the newly set standards and address perineal trauma properly should also be enacted to spur compliance with the new guidelines. Thus, a combination of positive punishment and positive reinforcement is expected to lead to the best results in prompting the change in the midwifery setting. Advocating for women’s rights to avoid damage to their health and receive services of the proper quality will hopefully lead to improvements in outcomes of perineal trauma management.

The problem of encouraging teamwork and cross-disciplinary collaboration between midwives, nurses, and physicians may also pose a threat to the well-being of patients. To detect the case of a complicated pregnancy, cooperation between nurses, midwives, and physicians will be required, which, in turn, maybe a difficult goal to achieve due to inherent conflicts within a multidisciplinary team (Frost, Gundry, Young, & Naguib, 2016).

Since the time that midwives have for managing the needs of women is very restricted, direct and concise standards for addressing dilemmas in the neonatal care setting will have to be provided, with the emphasis on beneficence, nonmaleficence, and patient autonomy (Frost et al., 2016). Therefore, the brochure will contain several points concerning the management of conflicting situations and dilemmas in the instances of perineal trauma.

In addition, creating homogenous instructions for perineal trauma is likely to be quite difficult due to the need to take into account the unique characteristics of different patients. For example, the incorporation of instructions for giving women antenatal perineal message may vary depending on patient-specific needs. Specifically, the signs and symptoms that show the need to deploy antenatal perineal massage may vary vastly across different body types and anatomical specifics of women’s bodies (Iferikigwe, Obi, Eleje, & Ozumba, 2018). Thus, tools for establishing the dialogue between pregnant women and nurses to inform the latter about possible challenges in managing the process of childbirth will be needed. Consequently, the reconsideration of the current framework for cross-cultural communication will be necessary.

To address the issue of instructions, one will need to develop the standards for care that will be used as the principal guide for taking necessary actions. In addition to the key steps, extra opportunities for alleviating the pain experienced by the patient and addressing the problem of tears and similar cases of perineal trauma will be detailed.

Apart from barriers to providing perineal care, several facilitators should be outlined. Making efficient use of these factors will allow nurses to advocate for patients’ needs in the midwifery setting and cater to the culture-specific requirements of each woman. For example, the presence of innovative and diverse treatment options that can help in managing perineal issues will facilitate better care (Priddis, Dahlen, & Schmied, 2012). Obstetric gel and similar medications that reduce the painful experiences and the inflammation of the area should be incorporated into the trauma management process (Ashwal et al., 2016).

In order to implement the proposed strategy in the obstetrics setting, nurses will have to receive training that will assist them in applying the new guidelines to the management of perineal trauma. Courses for increasing the range of midwives’ competencies and assisting them in improving their responses to the needs of pregnant women will be designed. During the education program, the elements of cross-cultural communication will be considered as the means of managing the situations that will involve communication with women from different socio-cultural backgrounds.

Besides the training needed to develop skills for applying immediate treatment measures to perineal traumas, nurses and midwives will also be instructed about the strategies for addressing the needs of pregnant women from diverse backgrounds. The importance of cross-cultural communication and respectful attitudes toward cultural beliefs of women representing ethnic minorities will be conveyed to nurses. The study of culture-specific challenges that nurses face when addressing the cases of perineal trauma will help to minimize the threats to which women and their children are exposed.

Moreover, a study of women’s experiences linked to the development of perineal trauma during childbirth will allow understanding of how nurses can assist the target population and how nurse-patient communication can be improved. According to Priddis, Schmied, and Dahlen (2014), the analysis of the coping mechanisms that women develop during their suturing experiences informs nurses about the measures that can be employed to forward the communication. Moreover, the analysis of the specified cases will point to the signs and symptoms to which nurses will need to pay especially close attention when estimating the probability of perineal trauma and locating the methods of managing it.

References

Aasheim, V., Nilsen, A. B. V., Reinar, L. M., & Lukasse, M. (2017). Perineal techniques during the second stage of labor for reducing perineal trauma. Cochrane Database of Systematic Reviews, 1(6), 1-118. Web.

Abedzadeh-Kalahroudi, M., Talebian, A., Sadat, Z., & Mesdaghinia, E. (2019). Perineal trauma: incidence and its risk factors. Journal of Obstetrics and Gynaecology, 39(2), 206-211. Web.

Ashwal, E., Aviram, A., Wertheimer, A., Krispin, E., Kaplan, B., & Hiersch, L. (2016). The impact of obstetric gel on the second stage of labor and perineal integrity: A randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine, 29(18), 3024-3029. Web.

Aguiar, M., Farley, A., Hope, L., Amin, A., Shah, P., & Manaseki-Holland, S. (2019). Birth-related perineal trauma in low-and middle-income countries: A systematic review and meta-analysis. Maternal and Child Health Journal, 23(8), 1048-1070. Web.

Floyd Jr, M. S., Omar, A. M., & Khattak, A. Q. (2017). A rare case of suspected perineal nodular induration. Canadian Urological Association Journal, 11(8), 288-288. Web.

Frohlich, J., & Kettle, C. (2015). Perineal care. BMJ Clinical Evidence, 1401(1), 1-23.

Frost, J., Gundry, R., Young, H., & Naguib, A. (2016). Multidisciplinary training in perineal care during labor and delivery for the reduction of anal sphincter injuries. International Journal of Gynecology & Obstetrics, 134(2), 177-180. Web.

Leon-Larios, F., Corrales-Gutierrez, I., Casado-Mejía, R., & Suarez-Serrano, C. (2017). Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial. Midwifery, 50, 72-77. Web.

Lodge, F., & Haith-Cooper, M. (2016). The effect of maternal position at birth on perineal trauma: A systematic review. British Journal of Midwifery, 24(3), 172-180. Web.

Priddis, H., Schmied, V., & Dahlen, H. (2014). Women’s experiences following severe perineal trauma: A qualitative study. BMC Women’s Health, 14(32), 1-11. Web.

Ugwu, E. O., Iferikigwe, E. S., Obi, S. N., Eleje, G. U., & Ozumba, B. C. (2018). Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 44(7), 1252-1258. Web.

Priddis, H., Dahlen, H., & Schmied, V. (2012). Women’s experiences following severe perineal trauma: A meta-ethnographic synthesis. Journal of Advanced Nursing, 69(4), 748-759. Web.

World Health Organization. (2018). WHO recommendation on techniques for preventing perineal trauma during labour. Web.

Lawrence, L., Rebecca, R., Noelle, B., Dusty, T., & Clifford, Q. (2016). The effect of perineal lacerations on pelvic floor function and anatomy at six months postpartum in a prospective cohort of nulliparous women. Birth, 43(4), 293-302. Web.

Royal College of Obstetricians and Gynaecologists. (2015). The management of third- and fourth-degree perineal tears. Web.

Steen, M., & Diaz, M. (2018). Perineal trauma: A women’s health and wellbeing issue. British Journal of Midwifery, 26(9), 574-584. Web.

Zhang, Y., Huang, L., Ding, Y., Shi, Y., Chen, J., & McArthur, A. (2017). Management of perineal pain among postpartum women in an obstetric and gynecological hospital in China: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 15(1), 165-177.

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