A Survey of methods used by nurse-midwives to facilitate delivery over an intact perineum.
Creators: name: Vigdor-Odato, Karen
Publisher: name: University of Utah
Year: 2012
Subjects: Perineum
Attitudes

description: The purpose of this study was to determine the attitudes of nurse-midwives concerning delivery over an intact perineum, their techniques utilized to facilitate delivery over an intact perineum, and the effectiveness of these techniques.  Questionnaires were mailed to 175 C.N.M.s. One hundred and thirteen were returned completed.  More than half of the 113 respondents in this study graduated from nurse-midwifery schools within the past six years and have hour years or less of clinical practice.  Twenty-two schools of nurse-midwifery and 34 states are represented.  A large majority of the respondents do not do routine episiotomies and prefer to deliver over an intact perineum whenever possible.  Varied and numerous techniques are used by these C.N.M.s to facilitate delivery over an intact perineum.  A large majority teaches berating and pushing techniques, Kegels exercise, and tailor sitting/squatting during pregnancy.  Most do not use any special techniques during the first stage of Labor.  During the second stage of labor, most practitioners prefer to maintain flexion of the fetal head, to use some kind or perineal massage or support, and to not use anesthesia.  The preferred positions for deliver are the lithotomy position (flat or raised) without stirrups and the lateral Sims positions.  Gentle, intermittent pushing is preferred.  The techniques reported to be most helpful to successful delivery over an intact perineum include having a controlled, prepared client, a delivery position with legs relatively close together, using gentle pushing and pushing between contractions, assuring a very slow delivery and delivery between contractions, maintaining flexion of the babyâ€™s head, and having the women pant or breath the head out.  The techniques that participants reported most often to be detrimental to delivery over an intact perineum include using stirrups and/or having the legs far apart, hard pushing, hurrying, and having an uncontrolled, unprepared client.  The success of the techniques utilized was unable to be determined from the available data.  Success rates were calculated for the 36 respondents for whom delivery statistics were available.  These success rates were widespread and varied for 8% to 100%. Success was neither related to the race or tissue integrity of client populations, nor to practitionersâ€™ preferences about delivery over intact perineums.  Success was not correlated with the number of years of clinical practice.  It was concluded from this study that nurse midwives are interested in learning more and better methods of delivering over an intact perineum.  The efforts of present-day nurse-midwives to protect the perineum during childbirth are as varied and numerous as those that have been used historically.  The old methodsâ€"oils, heat support, herbsâ€"are all represented in current practice. Limitations to the study were examined and recommendations for further study in this area were made.  Implications for nurse-midwifery practice and education were discussed.