Does midwife experience affect the rate of severe perineal tears?. Issue 2 (15th February 2017)

• Record Type: Journal Article
• Authors: Mizrachi, Yossi; Leytes, Sophia; Levy, Michal; Hiaev, Zvia; Ginath, Shimon; Bar, Jacob; Kovo, Michal
• Is Part Of: Birth. Volume 44:Issue 2(2017)
• Page Start: 161
• Page End: 166
• Publication Date: 2017-02-15
• Subjects: midwives -- OASIS -- obstetric lacerations -- perineal tears; Childbirth -- Periodicals; Obstetrics -- Periodicals; Newborn infants -- Care -- Periodicals; Natural childbirth -- Periodicals; 618.1
• DOI: 10.1111/birt.12278
• Languages: English
• ISSNs: 0730-7659

Abstract

Abstract: Background: Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree). Methods: A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders. Results: Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P =.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91–0.99, P =.03). Conclusion: 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.