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The severity of second-degree perineal tears and perineal pain during three months postpartum: A prospective cohort study

2025-07-08T03:05:02Z

Title: The severity of second-degree perineal tears and perineal pain during three months postpartum: A prospective cohort study Authors: Risløkken, Jeanette; Macedo, Marthe Dalevoll; Bø, Kari; ¨ Engh, Marie Ellstrom; Siafarikas, Franziska Abstract: Background: Second-degree perineal tears are common and can vary widely in the extent of tissue trauma. Therefore, a better understanding of perineal pain based on tissue trauma severity in second-degree tears is needed. Aim: The primary aim of this study was to assess differences in perineal pain according to the severity of perineal tears, with a focus on subcategories of second-degree tears, during the first three months postpartum. The secondary aim was to assess the use of pain medication and breastfeeding patterns according to the severity of the second-degree tears. Methods: In this observational cohort study, nulli- and multiparous women with singleton pregnancies were included during pregnancy. After birth, perineal tears were classified using the latest international classification system. In addition, second-degree tears were subcategorised according to percentage of damage to the perineum (<50 %=2A,>50 % but less than entire perineum=2B, affecting entire perineum, anal sphincter not involved=2C). Perineal pain, use of pain medication and breastfeeding patterns were assessed during a phone interview seven to ten days postpartum and through an electronic questionnaire three months postpartum. Findings: Out of 880 vaginal births, 852 participants completed the phone interview and 715 answered the electronic questionnaire. During the first three months postpartum, women with 2C-tears reported statistically significantly higher pain scores and more frequent use of pain medication compared to women with 2A-tears. There was no statistically significant difference between the number of participants not breastfeeding between second-degree tear subcategories. Conclusion: Women with 2C-tears reported higher perineal pain scores and more use of pain medication compared to those with less severe tears during three months postpartum.

Patient perception of labor support behaviors provided by Finnish midwives

2025-07-08T03:02:00Z

Title: Patient perception of labor support behaviors provided by Finnish midwives Authors: Koski, Pirjo; Raussi-Lehto, Eija; Leskinen, Paivi ¨; Klemetti, Reija Abstract: Background: Almost all births in Finland occur in hospitals, but the concept of labor support behavior is not wellknown among Finnish midwives. Objective: The primary aim was to increase perceived labor support as measured by BANSILQ. Methods: This study was tailored to evaluate the impacts of short on-the-job training interventions for midwives (n=70) in labor support given to mothers. The training was conducted at one university hospital and and one regional hospital during 2012. The trainings were carried out twice at both hospitals to reach as many miwdwives as possible to participate. Two university hospitals—one regional and one central—were selected as controls. New mothers were asked to complete the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (BANSILQ) in the postpartum wards at all the selected hospitals before the intervention (n=1500) and after the intervention (n=1500). The data were linked to the Finnish Medical Birth Register (MBR). As this is an in-job training intervention study and not a trial, it has not been registered in a trial registry. Results: The response rate was 68% (n=1020) for the pre-intervention survey and 47% (n=704) for the postintervention survey. At the regional-level intervention hospital, the mean length of the second stage of childbirth decreased significantly. A bonding time of at least three minutes was three times more likely at both intervention hospitals. Support for breastfeeding was twice as likely at the university-level hospital after the intervention. In all the study hospitals, mothers with less education were more likely to receive tangible and informal support than highly educated mothers. Conclusions: This short on-the-job intervention did not increase labor support provided by Finnish midwives in its entirety, and the effect on birth outcomes was minimal. However, support for breastfeeding increased, and some types of support were targeted at those who needed it most. To improve midwifery care, both training and sufficient resources are needed.

Obstetric and medical factors rather than psychosocial characteristics explain why eligible women do not complete the enhanced recovery after elective caesarean (EREC) pathway: A prospective cohort study

2025-07-08T02:59:25Z

Title: Obstetric and medical factors rather than psychosocial characteristics explain why eligible women do not complete the enhanced recovery after elective caesarean (EREC) pathway: A prospective cohort study Authors: Digenis, Christianna; Salter, Amy; Cusack, Lynette; Turnbull, Deborah Abstract: Background: An Australian health-service implemented an ‘enhanced recovery after elective caesarean’ pathway with next-day discharge. Problem: Previous anecdotal reports indicated that a large percentage of eligible women were not discharged the next day and therefore were not regarded as having completed the pathway. Psychosocial factors were expected to be the leading reason for prolonged hospitalisation. Aim: The study objectives were to: enumerate the percentage of women assessed as eligible for EREC who subsequently did not complete the pathway and the reasons; and to describe women’s antenatal satisfaction with preparation, preferences, and perceived support. Women who completed the pathway versus those who did not were compared on antenatal biopsychosocial characteristics. Methods: This exploratory prospective cohort study enrolled consenting eligible women from antenatal clinics and used patient records and questionnaire data. Comparative statistical techniques were used. Findings: 62 % of women did not complete the pathway, with medical and obstetric factors being the most common reasons (80 %). There was statistically significant evidence of lower antenatal stress levels for those who completed EREC (median=5) relative to those who did not (median=8; P = 0.035); although these findings may not be of clinical importance. Antenatally, 51 % of women felt prepared for early discharge, 36 % needed more information, 19 % disliked hospital, 93 % agreed that family togetherness after birth was important. Most agreed that staff (76 %) and family (67 %) supported the pathway. Conclusion: This study indicated that a large percentage of women assessed as eligible did not complete EREC and that obstetric and medical factors, rather than psychosocial characteristics, largely explained this. This provides reassurance to clinicians and women that discharge home is working as intended and is useful for planning similar models of care. Higher stress levels in the antenatal period were demonstrated for women who did not complete EREC suggesting the need for further research into how to support these women.

Navigating a maze: Midwives’ identity response to the enactment of an abortion law in Chile

2025-07-08T02:55:14Z

Title: Navigating a maze: Midwives’ identity response to the enactment of an abortion law in Chile Authors: Carvajal, Bielka; White, Helen; Brooks, Jane; Thomson, Ann M; Cooke, Alison Abstract: Background: Chilean midwives have been identified as essential for successfully implementing an abortion law, a practice which could potentially be understood as contradicting their central mission. Nevertheless, to date, there has been no investigation into how Chilean midwives have incorporated induced abortion care provision into their professional identity. Objective: To elucidate how Chilean midwives understand and provide abortion care and how they have (re) defined their professional identity to include induced abortion care. This article reports the findings of the second part of this aim. Methods: This study was underpinned by a constructivist grounded theory methodology informed by a reproductive justice and feminist perspective. Midwives from Chile who have cared for women undergoing abortion were invited to participate in the study. After purposive and theoretical sampling, fifteen midwives were recruited. Findings: Midwives’ identity is woman-centred, with high value placed on their role protecting life. These two aspects of midwives’ identity are in contradiction when providing abortion care. Midwives’ identity results from and informs midwives’ practice. Midwifery regulation influences both practice and identity. The model ‘Navigating a maze’ explains the interaction of these three elements. Conclusion: Midwives’ identity response to the enactment of the Chilean abortion law is an example of how professional identity must navigate regulation and practice to make sense of its purpose. In light of this study’s findings, the current tension experienced in midwives’ identity should be carefully attended to prevent adverse outcomes for midwives and the Chilean population.