Midwives' lived experience of a birth where the woman suffers an obstetric anal sphincter injury--a phenomenological study.

Malin Edqvist,Ingela Lundgren,Helena Lindgren

doi:10.1186/1471-2393-14-258

Malin Edqvist, Ingela Lundgren + Show 1 more

Open Access

https://doi.org/10.1186/1471-2393-14-258

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Abstract

BackgroundThe occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years. The consequences of these injuries can be devastating for women and have an impact on their daily life and quality of health. The aim of this study was to obtain a deeper understanding of midwives’ lived experiences of attending a birth in which the woman gets an obstetric anal sphincter injury.MethodsA qualitative study using phenomenological lifeworld research design. The data were collected through in-depth interviews with 13 midwives.ResultsThe essential meaning of the phenomenon was expressed as a deadlock difficult to resolve between a perceived truth among midwives that a skilled midwife can prevent severe perineal trauma and at the same time a coexisting more complex belief. The more complex belief is that sphincter injuries cannot always be avoided. The midwives tried to cope with their feelings of guilt and wanted to find reasons why the injury occurred. A fear of being exposed and judged by others as severely as they judged themselves hindered the midwives from sharing their experience. Ultimately the midwives accepted that the injury had occurred and moved on without any definite answers.ConclusionsBeing caught between an accepted truth and a more complex belief evoked various emotions among the midwives. Feelings of guilt, shame and the midwife’s own suspicion that she is not being professionally competent were not always easy to share. This study shows the importance of creating a safe working environment in which midwives can reflect on and share their experiences to continue to develop professionally. Further research is needed to implement and evaluate the effect of reflective practices in relation to midwifery care and whether this could benefit women in childbirth.

Highlights

The occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years
Essential structure The essential structure of being a midwife when the woman suffers an obstetric anal sphincter injury during childbirth is to confront a truth, which is perceived as well known among midwives
At the same time the midwife has to relate to a more complex belief, which implies that sphincter injuries cannot always be avoided no matter what the midwife does during the active phase of the second stage and the birth of the baby

Summary

Introduction

The occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years. The occurrence of obstetric anal sphincter injuries (OASIS) has increased in Sweden during the last twenty years even though there has been a slight reduction in the prevalence from 4.2% to 3.5% in the last few years [1]. The consequences of these injuries can be devastating for women [2] and involve symptoms such as perineal pain, dyspareunia [3] and faecal incontinence [4]. The experience of obstetric anal sphincter injuries during childbirth appears to be a complex phenomenon that affects the women both physiologically and psychologically and alters the women’s understanding of their identity as sexual beings [2]

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