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

BackgroundMidwives are reported to have changed from hands on' to hands poised or off' approaches to 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. AimsTo determine which perineal protections techniques midwives prefer for low-risk non-water births; whether preference is associated with technique taught or with other characteristics; and whether midwives change preference according to clinical scenario. Materials and MethodsMidwives in Northern Sydney Local Health District (NSLHD) were surveyed during a 2-week period in 2014. Multiple-choice questions were used, with free text option. Descriptive analyses, chi-square and McNemar tests were undertaken. ResultsOne 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' whether there was concern about an impending OASI. There has been a shift over time from teaching hands on' to hands poised or off'. ConclusionThe 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 whether there is an association with the rising OASI rate and the change in preferred perineal management technique for a low-risk birth.