Fear causes tears - Perineal injuries in home birth settings. A Swedish interview study.docVIP

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Fear causes tears - Perineal injuries in home birth settings. A Swedish interview study.doc

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Fear causes tears - Perineal injuries in home birth settings. A Swedish interview study

Lindgrenetal.BMCPregnancyandChildbirth2011,11:6 /1471-2393/11/6 RESEARCH ARTICLE OpenAccess Fearcausestears-Perinealinjuriesinhomebirth settings.ASwedishinterviewstudy HelenaELindgren1,2*,?saBrink1?andMarieKlingberg-Allvin1? Abstract Background:Perinealinjuryisaseriouscomplicationofvaginaldeliverythathasasevereimpactonthequalityof lifeofhealthywomen.Theprevalenceofperinealinjuriesamongwomenwhogivebirthinhospitalhasincreased overthelastdecade,whileitisloweramongwomenwhogivebirthathome.Theaimofthisstudywasto describethepracticeofmidwivesinhomebirthsettingswiththefocusontheoccurrenceofperinealinjuries. Methods:Twentymidwiveswhohadassistedhomebirthsforbetweenoneand29yearswereinterviewedusing aninterviewguide.Themidwivesalsohadexperienceofworkinginahospitaldeliveryward.Alltheinterviews weretape-recordedandtranscribed.Contentanalysiswasused. Results:Theoverallthemewas“Norushingandtearingabout”,describingthemidwives’focusonthenatural processtakingitstime.Thesubcategories1)preparingforthebirth;2)goingalongwiththephysiologicalprocess; 3)creatingasenseofsecurity;4)thecriticalmomentand5)midwiferyskillsilluminatethemanagementoflabor asexperiencedbythemidwiveswhenassistingbirthsathome. Conclusions:Midwiveswhoassistwomenwhogivebirthathometakemanythingsintoaccountinorderto minimizetheriskofcomplicationsduringbirth.Protectionofthewoman’sperineumisanactofawarenessthatis notlimitedtotheactualmomentofthepushingphasebutstartsearlier,alongwiththecommunicationbetween themidwifeandthewoman. Background Riskfactorsforanalsphincterruptureduringdelivery Perinealinjuriesandanalsphincterrupturesareserious are described as nulliparity, high birth weight of the complicationsofvaginaldelivery.Mostcommonconse- child, instrumental deliveries, episiotomy, adverse birth quences of perineal injury are pain and incontinence, position, maternal age and epidural analgesia [4,5]. which affect the quality of life of healthy women [1]. Womenwhoweredeliveredinasemi-sittingpositionor Other conseq