Abstract
BackgroundObstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women.MethodsNurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated.ResultsTwenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations.ConclusionCounty nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears.
Highlights
Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings
Synopsis Nurse-midwives in western Kenya have multiple barriers to diagnosing third- and fourth-degree obstetric lacerations, a finding which may contribute to the overall fistula burden in Kenya
We hypothesized that barriers to timely repair of third- and fourth-degree perineal tears in western Kenya included failure to diagnose due to knowledge gaps and health system dysfunction
Summary
Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Obstetric fistula (OF) is a disabling medical condition that results in fecal and/or urinary incontinence due to the OF is a complication of childbirth that has been nearly eliminated in high-income countries, but continues to burden women in low- and middle-income countries [1, 4]. In these settings, obstructed labor is thought to account for the majority of OF cases [5, 6]. We conducted a multi-method assessment of post-delivery practices and competencies of one cadre of skilled birth attendants, Kenyan nurse-midwives, with the hope that the results could inform the development of an innovative community-based solution
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
