Developing a tool to assess perineal trauma

Perineal trauma during childbirth is an extremely common phenomenon and 60–70% of women with perineal trauma will require suturing. Although the evidence to support non-suturing of the perineum is limited and inconclusive, in recent years there has been an increasing unexplained trend among midwives to leave some second-degree tears to heal without sutures. Second-degree trauma can be slight or severe, with complicated muscle damage, and midwives often disagree on what constitutes a tear that needs suturing. Lack of conformity in assessing perineal trauma would be a potential threat to the validity of a randomised, controlled trial to compare the effects of suturing and non-suturing of perineal trauma. The aim of this study was to develop a tool that would allow uniform evaluation of perineal trauma. The use of a perineal assessment tool is recommended to improve documentation and promote a standardised approach to perineal assessment. </jats:p

Findings from a UK feasibility study of the Centering Pregnancy® model

CenteringPregnancy® is a model of group antenatal care which was devised and developed in the United States. A feasibility study was conducted in South East London from 2008 to 2010, to assess if the model could be introduced into NHS settings, if women would be prepared to join a group model of care and to explore the views of the women, their partners and midwives who participated. This was the first time the model had been implemented in the UK. Six antenatal groups, attended by 60 women and their partners and facilitated by 12 midwives, were established for the feasibility study with a seventh group of 8 women and their partners established later to bring the learning together and inform an operational guidance document ( Gaudion and Menka, 2011 ). Women whose pregnancies were classed as low or high risk could opt for group antenatal care at the study site after discussion with a midwife at their antenatal booking visit. Integral components of the CenteringPregnancy model are the evaluations of care which women and their partners are asked to provide in late pregnancy and at one month after the birth of their baby. The midwives who facilitate the groups are also required to complete evaluation forms and to contemporaneously reflect and enhance the care they offer, if this is appropriate. Feedback from these sources, together with an evaluation of the means of learning in the development process, was very positive and has informed the ongoing roll-out of the model at the study site. The potential to conduct randomized controlled trials in the UK to assess the clinical utility and cost-effectiveness of group antenatal care compared with individual antenatal care for women in low- and high-risk obstetric populations should now be considered. </jats:p