Abstract
BackgroundMedical staff’s influence on patient outcomes has become a subject of interest. We evaluated experienced midwives and compared their performance concerning perineal lacerations (PL).MethodsIn a retrospective cohort study, 1937 women with singleton pregnancies who had delivered spontaneously with a cephalic presentation by experienced midwives in the Medical University of Vienna from January 2009 to April 2014 were included. As predictive parameters, we included basic patient-, pregnancy- and delivery-related characteristics including the individual midwife who delivered the child. The incidence of PL was the main outcome measure.ResultsOverall PL and severe PL were found in 508/1937 (26.2 %) and 19/1937 women (1.0 %), respectively. In a multivariate analysis for PL of any degree, maternal age (ß = 0.170 ± 0.080), gestational age at delivery (ß = 0.190 ± 0.320), and birth weight (ß = 0.002 ± 0.000) significantly increased the risk, whereas multiparity (ß = −0.379 ± 0.141) and mediolateral episiotomy (ß = −1.514 ± 0.284) decreased it (p < 0.05). In addition, the individual midwife who delivered the child was a significant influencing factor, with ß-values ranging from −0.028 to 0.899 compared to the reference midwife. For severe PL, the midwife was not of significant influence.ConclusionsThe individual midwife is an independent factor that influences the risk for overall PL, not for severe PL. Other risk factors include maternal age, gestational age at delivery, birth weight, parity and episiotomy.
Highlights
Medical staff’s influence on patient outcomes has become a subject of interest
In univariate analysis, maternal age, gestational age at delivery, birth weight, and head circumference were positively correlated with the incidence of perineal lacerations, whereas women who had given birth to ≥2 children previously and/or who had undergone mediolateral episiotomy experienced a decreased risk
The major finding of this retrospective study is that the midwife is an independent predictive factor for the occurrence of perineal lacerations during a vaginal delivery
Summary
Medical staff’s influence on patient outcomes has become a subject of interest. We evaluated experienced midwives and compared their performance concerning perineal lacerations (PL). Every individual surgeon would have an individual risk profile for surgical outcome [3, 4] This applies to trainees, and to experts, as demonstrated in the field of thyroid surgery [1, 3, 4]. In the field of obstetrics, many healthcare organizations and commission advise regular interdisciplinary training including both midwives and doctors, at least for emergencies This should overcome the most common errors, namely confusion in roles and responsibilities, poor communication between staff as well as errors on the individual level including failure to prioritize management actions and failure to perform clinical tasks in a structured manner [5]. The fact that the individuals’ performances is of impact is supported
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