“A patchwork of services” – caring for women who sustain severe perineal trauma in New South Wales – from the perspective of women and midwives

Abstract

BackgroundCurrent research into severe perineal trauma (3rd and 4th degree) focuses upon identification of risk factors, preventative practices and methods of repair, with little focus on women’s experiences of, and interactions with, health professionals following severe perineal trauma (SPT). The aim of this study is to describe current health services provided to women in New South Wales (NSW) who have experienced SPT from the perspective of Clinical Midwifery Consultants (CMC) and women.MethodsThis study used a descriptive qualitative design and reports on the findings of a component of a larger mixed methods study. Data were collected through a semi-structured discussion group using a variety of non-directive, open-ended questions leading CMCs of NSW. A survey was distributed prior to the discussion group to collect further information and enable a more comprehensive understanding of services provided. Data from individual interviews with twelve women who had experienced SPT during vaginal birth is used to provide greater insight into their interactions with, and ease of access to, health service providers in NSW. An integrative approach was undertaken in reporting the findings which involved comparing and analysing findings from the three sets of data.ResultsOne overarching theme was identified: A Patchwork of Policy and Process which identified that current health services operate in a ‘patchwork’ manner when caring for women who sustain SPT. They are characterised by lack of consistency in practice and standardisation of care. Within the overarching theme, four subthemes were identified: Falling through the gaps; Qualifications, skills and attitudes of health professionals; Caring for women who have sustained SPT; and Gold standard care: how would it look?ConclusionThe findings from this study suggest that current health services in NSW represent a ‘patchwork’ of service provision for women who have sustained SPT. It appeared that women seek compassionate and supportive care based upon a clear exchange of information, and this should be considered when reflecting upon health service design. This study highlights the benefits of establishing multi-disciplinary collaborative specialist clinics to support women who experience SPT and associated morbidities, with the aim of providing comprehensive physiological and psychological support.

A systematic mixed studies review of women's experiences of perineal trauma sustained during childbirth

“…a defect in their anatomy/pushing incorrectly) or externally focussed (e.g. the actions of others/instruments used), (Priddis, Schmied, & Dahlen, ; Priddis, Schmied, Kettle, Sneddon, & Dahlen ; Thompson & Walsh, ). Those with OASI who felt the cause of their tear was external, described how they felt “let down by the system” (Priddis, Schmied, & Dahlen, ; Priddis, Schmied, Kettle, et al., ).…”

“…the actions of others/instruments used), (Priddis, Schmied, & Dahlen, ; Priddis, Schmied, Kettle, Sneddon, & Dahlen ; Thompson & Walsh, ). Those with OASI who felt the cause of their tear was external, described how they felt “let down by the system” (Priddis, Schmied, & Dahlen, ; Priddis, Schmied, Kettle, et al., ). Women also described a lack of knowledge about the different degrees of perineal trauma, believing that every tear is severe, as this was the only type of tear they heard about from others (Priddis, Schmied, & Dahlen, ; Thompson & Walsh, ).…”

“…They described the daily struggle to manage their symptoms and the isolation and loneliness they experienced when keeping incontinence hidden from others, particularly anal incontinence (Tucker, Clifton, & Wilson, ). Women described how they felt it was not culturally appropriate to talk about their difficulties with friends or family due to the social stigma of being incontinent and being perceived as dirty and/or lazy (Gillard & Shamley, ; Herron‐Marx et al., ; Priddis, Schmied, & Dahlen, ; Priddis, Schmied, Kettle, et al., ; Tucker et al., ).…”

Compassion in healthcare: a concept analysis

“…Compassionate behaviours included: eye contact [28], engaged body language [29], listening with full attention [30][31][32] and facial expressions which matched the subject of conversation [33]. All of these were deemed to display commitment and devotion by the health professional to what was being said, the significance of the topic and therefore demonstrated they were vested in them [34,35].…”

“…Patients want the health professionals to understand and appreciate the impact their current issue (diagnosis, bereavement, treatment etc.) is having on the physical, emotional and social rudiments of their life [30,31,33,51,52].…”