Perineal management techniques among midwives at five hospitals in New South Wales – A cross-sectional survey

Abstract

Background: Midwives are reported to have changed from ‘hands on’ to ‘hands poised or off’ approaches at birth at the same time as obstetric anal sphincter injuries (OASIs) are increasing. As perineal management details are not routinely collected, it is difficult to quantify practice. Aims: To determine which perineal protections techniques midwives prefer for low risk non-water births; if preference is associated with technique taught or with other characteristics; and if midwives change preference according to clinical scenario. Materials and Methods: Midwives in Northern Sydney Local Health District (NSLHD), NSW, were surveyed during a two week period in 2014. Multiple-choice questions were used, with free text option. Descriptive analyses, chi-square and McNemar tests were undertaken. Results: One hundred and eight midwives participated (response rate 76.7%). ‘Hands poised or off’ was preferred by 63.0% for a low risk birth. Current practice was associated with technique taught (p<0.01). For scenarios with increased OASI risk midwives reported switching to ‘hands on’, with 83.4% employing ‘hands on’ if there was concern about an impending OASI. There has been a shift over time from teaching ‘hands on’ to ‘hands poised or off’. Conclusion: The preferred technique for a low risk birth appears to have changed from ‘hands on’ to ‘hands poised or off’, but most midwives adopt ‘hands on’ in situations of high risk for OASI. Further research is needed to establish if there is an association with the rising OASI rate and the change in preferred perineal management technique for a low risk birth.