Midwifery management of second-degree perineal tears in New Zealand: A cross-sectional survey of practice.

Abstract

Second-degree tears are the most common form of perineal trauma occurring after vaginal birth managed by New Zealand midwives, although little is known about midwives' perineal practice. The aim of this study was to identify how midwives managed the last second-degree perineal tear they treated and the level to which their practice reflects National Institute for Health and Care Excellence guidelines. An (anonymous) online survey was conducted over a six-week period in 2013. New Zealand midwives who self-identified as currently practising perineal management and could recall management of the last second-degree tear they treated were included in the analysis. Of those invited, 645 (57.1% self-employed, 42.9% employed) were eligible and completed surveys. Self-employed midwives reported greater confidence (88.0% vs 74.4%, p<0.001) and more recent experience (85.1% vs 57.4%, p<0.001) with perineal repair than employed midwives. Midwives who left the last second-degree tear unsutured (7.3%) were more likely to report low confidence (48.9% vs 15.4%, p<0.001) and less recent experience with repair (53.2% vs 24.7%, p<0.001), and were less likely to report a digital-rectal examination (10.6% vs 49.0%, p<0.001), compared to midwives who sutured. Care consistent with evidence-based guidelines (performing a digital-rectal examination, 59.4% vs 49.3% p=0.005; optimal suturing techniques, 62.2% vs 48.7%, p=0.001) was associated with recent perineal education. Midwives' management of the last second-degree perineal tear is variable and influenced by factors including: employment status, experience, confidence, and perineal education. There is potential for improvement in midwives' management through increased uptake of evidence-based guidelines and through ongoing education.