Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS)

Trochez, Ruben; Waterfield, Malcolm; Freeman, Robert

doi:10.1007/s00192-011-1454-8

Cited by 57 publications

(53 citation statements)

References 29 publications

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“…Changes in the application of perineal protection techniques may also have played a role. [68][69][70][71] The implementation of manual assistance and perineal protection techniques during the second stage of labour have significantly reduced the incidence of perineal tears in Norway. 72,73 Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies), but is not routinely practiced in the UK.…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

345

270

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Objective To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends.Design A retrospective cohort study of singleton deliveries from a national administrative database.Setting The English National Health Service between 1 April 2000 and 31 March 2012.Population A cohort of 1 035 253 primiparous women who had a singleton, term, cephalic, vaginal birth.Methods Multivariable logistic regression was used to estimate the impact of financial year of birth (labelled by starting year), adjusting for major risk factors.Main outcome measure The rate of third-degree (anal sphincter is torn) or fourth-degree (anal sphincter as well as rectal mucosa are torn) perineal tears.Results The rate of reported third-or fourth-degree perineal tears tripled from 1.8 to 5.9% during the study period. The rate of episiotomy varied between 30 and 36%. An increasing proportion of ventouse deliveries (from 67.8 to 78.6%) and non-instrumental deliveries (from 15.1 to 19.1%) were assisted by an episiotomy. A higher risk of third-or fourth-degree perineal tears was associated with a maternal age above 25 years, instrumental delivery (forceps and ventouse), especially without episiotomy, Asian ethnicity, a more affluent socio-economic status, higher birthweight, and shoulder dystocia.Conclusions Changes in major risk factors are unlikely explanations for the observed increase in the rate of third-or fourth-degree tears. The improved recognition of tears following the implementation of a standardised classification of perineal tears is the most likely explanation.Keywords Episiotomy, instrumental delivery, severe perineal trauma, trends, vaginal delivery.

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Section: Comparison With Previous Literaturementioning

confidence: 99%

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Gurol‐Urganci

Cromwell

Edozien

et al. 2013

BJOG

345

270

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“…5 In this time period, while the obstetric community debated whether delivery of the child should be by hands-on or hands-off, a shift was noted from hands-on to hands-off among midwives in the UK6 as well as in Scandinavian countries 78 Recent observational studies from Norway, however, showed a reduction of OASIS from around 6 % to 3 % in vaginally delivering first time mothers when implementing a hands-on technique 9…”

Section: Introductionmentioning

confidence: 99%

Reducing the incidence of Obstetric Sphincter Injuries using a hands-on technique: an interventional quality improvement project

Rasmussen

Yding

Anhøj

et al. 2016

BMJ Qual Improv Report

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A main concern for women giving birth is the risk of obstetric anal sphincter injuries. In our department the incidence of sphincter injuries was around 8 % among vaginally delivering first time mothers. We aimed to halve the incidence to 4 % or less. A prospective interventional program was instituted. We implemented a hands-on technique with four elements in a bundle of care together with a certification process for all staff on the delivery ward. The incidence of episiotomies served as a balancing indicator.The adherence to three of the four elements of the care bundle rose significantly while the all-or-nothing indicator leveled around 80 %. The median number of deliveries between cases with a sphincter injury increased from 9.5 in the baseline period to 20 during the intervention period. This corresponded with a reduction in the incidence from 7.0 % to 3.4 %. The rate of episiotomy remained low at 8.4 % in this group. By implementing the hands-on technique, we halved the risk of obstetric anal sphincter injuries. Our data suggest that further improvement may be anticipated. The study has demonstrated how implementation of a hands-on technique can be carried out within a quality improvement framework with rapid and sustainable results.

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“…The results of the present study are supported by the results of Wu et al on 77 midwives in Singapore, in which maternal factors, neonatal factors and midwives factors were associated with increased risk of episiotomy. 13,14 Some delivery practices, such as 'hand on' compared with 'hands poised' for perineal guarding have been shown to be associated with higher rates of episiotomy, 15 and provider experience, beliefs and training are other potential factors that may influence episiotomy rates. 16 Improving midwifery care during delivery (giving enough time to the mother, encourage mother to be cooperate, no supine position and premium support during delivery, increase movement of the mother), reforming health system and health policy (increase number of midwives, decrease number of mothers admitted, no early admission, no giving early piton, supporting midwives, encourage for home delivery) and improving maternal care during pregnancy ( prenatal education and exercise, normal baby size) were midwives' opinion for decreasing the rate of episiotomy.…”

Section: Resultsmentioning

confidence: 99%

Midwives' perspectives regarding episiotomy practice in Kurdistan region/Iraq

Piro

Ahmed

2016

ZJMS

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IntroductionAn episiotomy is a surgical incision made into the perineum, which if required should only be performed immediately prior to birth to enlarge the vaginal outlet and to assist the birth of the baby.1 The reason for using episiotomy depends on the need to minimize the risks of severe spontaneous maternal trauma and fetal comprise. Performing episiotomy has undergone a number of revisions starting from 1920s when routine episiotomy was advocated to the 1980s when restrictive use of episiotomy became the recommended practice.3 There is no evidence to support the use of routine episiotomy in any circumstance, not even when there has been a previous third-degree tear. 1The World Health Organization also supports the restricted use of episiotomy (less than 20%) as there is no evidence that routine episiotomy decreases perineal damage. 4 Australian research has shown a high prevalence of maternal health problems up to six months after birth, with one or more health problems reported by 94% of women. Painful perineum (21%) and sexual problems (26.3%) were two of the most commonly cited. These problems were especially relevant to primiparous women and to women who had an episiotomy and/or instrumental birth. 5Episiotomy rates widely vary between countries, institutions, and individuals because of differences in attitudes and training.6 Wide practice variation in rate Background and objective: Local professional norms, experiences in tainting, and individual provider preference may lead to wide practice variation in rate and practice of episiotomy by midwives. The aim of this study was to find out the midwives' perspectives regarding practicing of episiotomy in three main cities of Kurdistan region/Iraq. Methods: A cross-sectional, descriptive study was conducted on 53 midwives working in delivery room in three maternity teaching hospitals in the three biggest cities of Kurdistan Region of Iraq. A questionnaire was constructed for the purpose of the study and data were collected by interview with midwives. F test and Chi-square test were used for analyzing the data. Results:The majority (88.7%) of midwives thought that the rate of episiotomy were high in their hospitals that were attributed to five factors; maternal (77.35%), fetal (39.62%), midwives (37.73%), obstetricians (30.18%) and hospital policy and health system (20.75%). The opinion of midwives regarding how to decrease the rate of episiotomy included improving midwifery care during delivery (77.35%), reforming health system (60.37%), reforming hospital policy (50.94%) and improving maternal care during pregnancy (26.41%). Conclusion: Taking into consideration the midwives' perspectives and views regarding episiotomy and providing training courses may help in decreasing the rate of episiotomy and its practice in correct way in Kurdistan's maternity hospitals.

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Hands on or hands off the perineum: a survey of care of the perineum in labour (HOOPS)

Abstract: The "hands off" the perineum technique is prevalent in the management of labour. We hypothesise that a possible consequence might be an increased incidence of obstetric anal sphincter injury.

Cited by 57 publications

References 29 publications

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Third‐ and fourth‐degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors

Reducing the incidence of Obstetric Sphincter Injuries using a hands-on technique: an interventional quality improvement project

Midwives' perspectives regarding episiotomy practice in Kurdistan region/Iraq

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