Program

Nurse-Midwifery M.S.

Number of Pages

56

Year Approved

2024

First Advisor

Wu, Katrina

Second Reader

Julie Ann Vingers

Abstract

Introduction: Perineal and vaginal lacerations are one of the most prevalent complications of vaginal birth. Third- and fourth-degree/severe lacerations put a woman at risk for bleeding, infection, chronic pain, sexual dysfunction and dyspareunia, pelvic and perineal pain, and urinary and fecal incontinence. The purpose of this review was to anthologize recent, applicable findings in order to equip maternal care providers with evidence-based recommendations for interventions that preserve perineal integrity. Methods: This integrative review utilized four databases to search for studies published between 2014-2024 that researched strategies for reducing perineal trauma during labor and birth. Using Covidence to aid in screening, 1728 articles were narrowed down to the final 33 that met full inclusion criteria for analysis. Results: Cost-effective and efficacious interventions in reducing severe lacerations included warm compress use and perineal massage, hands-on maneuvers such as Couder’s, the Finnish maneuver, and modified Ritgen’s maneuver. The presence of a second experienced midwife at delivery was determined as effective, as well as use of a perineal protection device. Open glottis vocalization during birth was related to decreased incidence of severe tears while assuming different positions during birth were related to varying grades of resulting tears; flexible sacrum positions were related to less incidence of severe tears in the perineum. No significant findings differed between land versus water birth, delayed versus immediate pushing and patient-led versus coached pushing in the nulliparous woman. Discussion: Though the overall findings are mixed, there was consistency in allowing women to move during labor to facilitate fetal rotation. Flexed sacrum positioning during birth, along with maternal vocalization should be encouraged. Applying a warm compress during the second stage and perineal massage are inexpensive and effective interventions a delivering provider can implement in an effort to protect the perineum. Other studied interventions should be considered on an individual basis in a shared decision-making approach.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis

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