Date of Award

1-1-1992

Degree Type

Thesis

Degree Name

Master of Nursing

Faculty

Faculty of Health and Human Sciences

First Advisor

Associate Professor Anne McMurray

Abstract

One of the major contributions that midwives can make to the comfort and well-being of child-bearing women is the skilful care of the perineum during delivery. This study investigated the short and long-term effects of perineal trauma in order to provide a basis for decision-making in the midwives' perineal management at delivery and client self-care. Specifically, the study examined the relationship between the extent of perineal trauma and the intensity and duration of perineal pain during the first three months following a vaginal birth; and compared discomfort among mothers whose perineal trauma was the result of an episiotomy, perineal, vaginal or labial lacerations, or who delivered with an intact perineum. All women, who required perineal repair during a six-month period at a large metropolitan hospital, were surveyed by a series of three structured questionnaires, at three days, six weeks and three months postpartum. One hundred and one women, who delivered over an intact perineum, were selected to serve as a control group. Analysis of variance with Tukey studentized Range (HSD) test using the General Linear Models Program, Wilcoxon matched-pairs signed-ranks test, Kruskal-Wallis chi-square approximation and chi-square analysis were applied to the data, using the SAS program. Results of the analyses demonstrated statistically significant differences between the perineal outcome subgroups. For the women who underwent an episiotomy during delivery, there was a general trend for increased pain and associated healing problems with the perineum. Further, factors found to be significantly associated with increased postpartum perineal pain were epidural analgesia and prior dyspareunia. Infant birthweight was significantly associated with perineal outcome. The results of this study will form the basis for: improving midwives' knowledge and understanding of perineal trauma, giving direction to the evaluation and revision of decision-making and clinical practice skills during delivery, integrating midwives' theory base and practice base, and anticipating associated problems with perineal trauma. The knowledge gained will provide a basis for guiding clients towards the ability to self-manage pain relief, overcome associated problems of perineal trauma, and their adaptation to the motherhood role.

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