Does midwife experience affect the rate of severe perineal tears?

Abstract

More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.

Risk factors for episiotomy during vaginal childbirth: A retrospective cohort study in Western China

“…In the study of Sagi‐Dain and Sagi, the rate of episiotomy performance by accoucheurs in practice for more than 15 years was significantly higher compared with their less experienced colleagues . In another study, however, highly experienced midwives (more than 10 years) performed episiotomies as frequently as inexperienced midwives (less than 2 years) . We speculate that experienced midwives may have better judgments of appropriate circumstances in which episiotomy may be beneficial to preventing extension of a tear to severe perineal tears or multiple lacerations, along with unawareness of the current practice guidelines, leading to a similar or higher prevalence of episiotomies as the inexperienced midwives.…”

Obstetric Anal Sphincter Injuries (OASIs) in Israel: A Review of the Incidence and Risk Factors

“…The reported rates of OASIs in Israel are 0.1%–0.6% ( Table 1 ). 4 , 6 , 12 – 17 The main risk factors are summarized in Table 2 and include instrumental deliveries, primiparity, fetal macrosomia, persistent occipito-posterior position, precipitate labor, prolonged second stage of labor, lower midwife experience, and vaginal birth after cesarean section.…”

“…These tears are associated with high rates of early complications, such as pain and infection, as well as late complications, such as chronic pain, dyspareunia, fecal incontinence, urinary incontinence, pelvic organ prolapse, fistula formation, and psychological problems. 4 Obstetric anal sphincter injuries are considered the most important risk factors for fecal incontinence, as a result of mechanical disruption of the anal sphincter muscles and/or damage to the nerves innervating these muscles. 5 …”

Is Vaginal Birth without an Episiotomy a Rarity in the 21st Century? Cross-Sectional Studies in Southern Poland

“…Episiotomies help ease births that are complicated by shoulder dystocia, prevent severe perineal tears (third and fourth degree, which happen in 0.3% of births), and shorten the second stage of labour, and also more commonly occur in obese women [ 14 , 15 ]. However, perineal protection with avoidance of an episiotomy is now considered to be an indicator of good maternal care by, among others, the REPROSTAT report for the European Commission [ 16 ].…”