Lubricant for Reducing Perineal Trauma: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background Different techniques have been reported to prevent perineal lacerations, but the effects of the use of lubricant have been unclear and is still subject of debate. Objective To assess the effect of lubricants on reducing perineal trauma during vaginal delivery. Search strategy PubMed, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang databases, ClinicalTrials.gov in 25 June 2021. Selection criteria Randomized controlled trials published in English or Chinese that compared the vaginal application of lubricant with standard care in women with cephalic presentation at vaginal delivery were included . Data collection and analysis Two independent reviewers selected eligible trials and extracted data on perineal trauma, duration of the second-stage labor, postpartum hemorrhage and Apgar score for meta-analysis. Main results Nineteen trials enrolling 5445 pregnant women were included. Compared with standard care, women using lubricants had a lower incidence of perineal trauma (RR 0.84, 95%CI 0.76 to 0.93), second-degree perineal laceration (RR 0.72, 95%CI 0.64 to 0.82) and episiotomy (RR 0.77, 95%CI 0.62 to 0.96), had a shorter duration of the second-stage labor (MD -13.72 minutes, 95%CI -22.68 to -4.77). Subgroup analysis indicated that women with obstetric gel had a shorter duration of the second-stage (MD -16.9 minutes, 95%CI -27.03 to -6.78 vs MD -8.38 minutes, 95%CI -11.11 to -5.65; P interaction=0.02) when compared with liquid wax. Conclusions Compared with standard care, lubricants could reduce the incidence of perineal trauma, especially second-degree perineal laceration, and shorten the duration of the second-stage labor.

Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

<p>Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.</p>

Lead maternity care midwives' perspectives on the effect of severe perineal trauma on their relationship with women

<p>Although childbirth is a time of happiness and joy for couples, happiness can be flawed by pain and discomfort associated with perineal trauma sustained during childbirth. It is estimated that 85% of vaginal births are accompanied by trauma to the perineum. A higher risk of trauma is sustained at the first birth compared with subsequent vaginal births. In New Zealand, midwives work in partnership with the woman. The Lead Maternity Care (LMC) midwife has an ongoing relationship with the woman in her care that starts when the pregnant woman books with the midwife and ends at six weeks postpartum. The relationship between the woman and the LMC midwife involves trust, shared control, responsibility and a shared meaning through mutual understanding. Midwives fear they will be held responsible by women who sustain severe perineal trauma during their birth for the outcome. There is a lack of research into how New Zealand midwives’ relationships are affected when women in their care sustain severe perineal trauma. This research sought to explore the experiences of LMC midwives who have cared for women who sustained severe perineal trauma during childbirth. The objective of this study was to understand the effects of severe perineal trauma on the midwife/ woman relationship. The aim was to explore LMC midwives` perception of how they were affected when women in their care sustained severe genital tract trauma during birth. Qualitative descriptive methodology was used. Face-to-face semi-structured interviews were conducted with LMC midwives from three geographical regions in lower North Island of New Zealand. The participants were eight midwives who had personal experience of caring for a woman who sustained severe genital tract trauma during childbirth. The findings revealed three themes: building a relationship with women, participants’ perceptions of the effects of severe perineal trauma on women, and the impact of severe perineal trauma on the midwife. The findings demonstrate that LMC midwives build relationships with women during the antenatal period. This relationship ensures an excellent partnership, established on the foundation of trust and respect, developed with the women. Midwives are affected on a personal and professional level when woman sustains trauma during childbirth, and the midwife adopts ways of coping. In the aftermath of severe perineal trauma, the woman may suffer health problems. This can impact her relationship with her LMC midwife during the postnatal period.</p>

New Zealand midwives' management of perineal trauma during childbirth: A survey of practice

<p>Background: Perineal trauma is the most common complication of vaginal birth and how this is treated has an impact on the incidence and duration of pain and dysfunction. Responsibility for the management of women’s perinea after uncomplicated births in New Zealand ordinarily rests with midwives although this is a little known aspect of practice. This study aimed to identify how midwives assess and manage second degree perineal trauma, the level to which their practice reflects best evidence, and what influences midwives’ decision-making. Methods: A descriptive approach using an online survey of 75 questions was used to access the population of 2910 New Zealand midwives. Inclusion criterion was current perineal management. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Interval data were analysed with a two-sample t-test. Results: 818 midwives returned a questionnaire, 744 (25% of the midwifery population) met the inclusion criteria. Evidence-based suturing material for repair of the last second degree tear was used by 96%. Correct suturing technique throughout all layers of repair was 42%. Rectal examination during assessment was performed by 45% increasing to 86% after repair. Confidence to repair was directly related to years since midwifery qualification (p<.001) and self-employment (p<.001). The tear was left unsutured by 7% and associated with reduced confidence with repair (p<.001), lack of recent experience with repair (p<.001), and home birth (p=.002). Unsutured tears were shorter than sutured tears (vaginal/perineal length, p<.001; depth, p=.004) and associated with delayed healing (p=.034). Care to six weeks postpartum was provided by 377 midwives. Perineal analgesia included oral medication (76%), pelvic floor exercises (44%), cooling (38%), and suppositories (31%). Visual assessments of healing were performed by 84% of midwives, 49% of women, and 7% of support people. Complications of infection (2%), pain (2%), and healing delay (3%) were uncommon. Conclusions: This research has added a New Zealand midwifery practice perspective to the existing literature on second degree perineal care. Potential for reductions in perineal morbidity were identified, even though New Zealand midwifery care already has a low rate of complications compared to international studies.</p>

New Zealand midwives' management of perineal trauma during childbirth: A survey of practice

<p>Background: Perineal trauma is the most common complication of vaginal birth and how this is treated has an impact on the incidence and duration of pain and dysfunction. Responsibility for the management of women’s perinea after uncomplicated births in New Zealand ordinarily rests with midwives although this is a little known aspect of practice. This study aimed to identify how midwives assess and manage second degree perineal trauma, the level to which their practice reflects best evidence, and what influences midwives’ decision-making. Methods: A descriptive approach using an online survey of 75 questions was used to access the population of 2910 New Zealand midwives. Inclusion criterion was current perineal management. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Interval data were analysed with a two-sample t-test. Results: 818 midwives returned a questionnaire, 744 (25% of the midwifery population) met the inclusion criteria. Evidence-based suturing material for repair of the last second degree tear was used by 96%. Correct suturing technique throughout all layers of repair was 42%. Rectal examination during assessment was performed by 45% increasing to 86% after repair. Confidence to repair was directly related to years since midwifery qualification (p<.001) and self-employment (p<.001). The tear was left unsutured by 7% and associated with reduced confidence with repair (p<.001), lack of recent experience with repair (p<.001), and home birth (p=.002). Unsutured tears were shorter than sutured tears (vaginal/perineal length, p<.001; depth, p=.004) and associated with delayed healing (p=.034). Care to six weeks postpartum was provided by 377 midwives. Perineal analgesia included oral medication (76%), pelvic floor exercises (44%), cooling (38%), and suppositories (31%). Visual assessments of healing were performed by 84% of midwives, 49% of women, and 7% of support people. Complications of infection (2%), pain (2%), and healing delay (3%) were uncommon. Conclusions: This research has added a New Zealand midwifery practice perspective to the existing literature on second degree perineal care. Potential for reductions in perineal morbidity were identified, even though New Zealand midwifery care already has a low rate of complications compared to international studies.</p>

Exploring the Complexities of Postpartum Sexual Health

Purpose of Review This paper explores the complexities of postpartum sexual health. It answers the question on what should be considered normal sexual health after birth and what should be considered abnormal. Recent Findings Many women experience physical sexual health issues in the months after birth, such as dyspareunia, lack of vaginal lubrication and a loss of sexual desire. For some women, these issues can persist 12 and 18 months after birth. Mode of birth is not associated with long-term dyspareunia 6 and 12 months after birth. There is conflict seen in the literature with regard to the association between perineal trauma and short-and long-term sexual health. Breastfeeding and the existence of pre-existing sexual health issues are strongly predictive of sexual health issues at 6 and 12 months after birth. Women have described a discordance in their sexual desire to that of their partner, for some this caused distress but for couples who communicated their feelings of sexual desire, concern over baby’s well-being and adapting to parenthood distress was not experienced. Resuming sexual intercourse after birth was not spontaneous, women considered their mode of birth, the presence of perineal trauma and their physical and emotional recovery from birth. One fifth of women had not resumed sexual intercourse 12 weeks after birth. Summary A discussion is presented on the challenges associated with viewing postpartum sexual health from a physical perspective only, and why prevalence studies alone do not capture the nuances of postpartum sexual health. Future research needs to take account of the psychosocial and relational dimensions of postpartum sexual health as well as physical dimensions.