What are the experiences of women and midwives of non-severe perineal trauma assessment? A meta-synthesis

Abstract

Background

In the UK, most women giving birth vaginally experience perineal trauma, predominantly non-severe, yet there is no validated assessment tool to evaluate wound healing postnatally. Current NICE guidelines provide only generic advice on how to complete this assessment, exposing the potential for a variety of non-standardised practices. Criticism of UK postnatal care is widespread, and inadequate perineal trauma assessment might contribute to this.

Question

What are the experiences of women and midwives of non-severe perineal trauma assessment?

Methods

Systematic literature review with meta-synthesis using three online databases. Data was synthesised using constant comparative analysis.

Databases

CINAHL, PubMed, and Web of Science.

Findings

Nine studies exploring the experiences of women (8/9) and midwives (1/9) on non-severe perineal trauma were included. Three themes emerged: ‘How society and healthcare professionals are silencing women's experiences’, ‘The inadequate provision of perineal care’, and ‘A glimmer of hope, examples of positive experiences’.

Discussion

Women report being underprepared about the extent of their perineal trauma, the potential impact on their lives and the services available if concerns. Some women are not offered perineal assessment and feel their concerns are trivialised by clinicians. These issues are not unique to the UK, as similar challenges exist globally. Improving postnatal care requires better communication, a therapeutic woman-midwife relationship, and societal change to reduce stigma around perineal trauma, which impacts women's psycho-physical health.

Conclusion

Improving postnatal perineal trauma care is crucial, with research needed on assessment practices and tools. Therapeutic relationships and women-centred clinical pathways can enhance experiences.