Abstract
Objective: To investigate how women experienced perineal trauma during a humanized birth. Methods: A qualitative study with 22 postpartum women was performed from January to December 2018. The Husserlian phenomenology was used as theoretical framework using individual, in-depth interviews that were audio-taped and transcribed verbatim. Results: Twenty-four categories emerged from women´s reports. During the prenatal phase, we found lack of information regarding perineal trauma, the alterity as a facilitating process to incentive women towards vaginal delivery and the perception of the beginning of an existential transition. During labor, it was noticed trust and attachment with the health professional giving physical and emotional support, the fear of the unknown linking to insecurity, the need for internal surrender to the process, empowerment as a result of trust and commitment, to give herself to the moment and no concerns with intrapartum injury but at the same time, having the possibility to share a decision-making process of suturing(or not). The postpartum period has shown the completion of the existential transition, the body as a place of estrangement, the loosening of some ties, but the construction of new networks of personal support to overcome postpartum. Conclusions: Most of women after humanized birth perceived perineal trauma as an existential transition that was initiated during antenatal period.
Highlights
IntroductionPerineal trauma is a frequent situation during labor and presents a diverse prevalence worldwide[1-3]; this event may influence the development of several pelvic floor disorders (urinary incontinence, fecal incontinence, chronic pelvic pain) and the decision for having another birth in the future[4]
Perineal trauma is a frequent situation during labor and presents a diverse prevalence worldwide[1-3]; this event may influence the development of several pelvic floor disorders and the decision for having another birth in the future[4]
Most patients practiced physical activity during gestation; yoga was the most prevalent activity (n=6). All participants had their deliveries assisted by an obstetrician; nineteen women were assisted by a midwife and 9 had a doula throughout the period
Summary
Perineal trauma is a frequent situation during labor and presents a diverse prevalence worldwide[1-3]; this event may influence the development of several pelvic floor disorders (urinary incontinence, fecal incontinence, chronic pelvic pain) and the decision for having another birth in the future[4]. More commonly entitled obstetric and anal sphincter injuries (OASIS), occurs less than 5% of deliveries and may increase the prevalence of the pelvic floor disorders (PFDs)[1]. Several risk factors are associated with severe perineal trauma: fetal macrosomia, instrumental delivery, prolonged second stage of labor, shoulder dystocia, nulliparity and Asian women[4]. There are some active measures that can be performed to reduce the incidence of perineal trauma such as controlled progress of the babys head, maternal position that allowed visualization of the perineum, selective episiotomy using lateral or mediolateral techniques[10]
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