Midwives’ lived experience of a birth where the woman suffers an obstetric anal sphincter injury – A phenomenological study

The occurrence of obstetric anal sphincter injuries has increased in Sweden during the last twenty years. From women’s point of view, the experience of sustaining a sphincter injury during childbirth appears to be a complex phenomenon that affects them both physiologically and psychologically and alters their understanding of their identity as sexual beings.

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Most of the research on sphincter injuries has focused on prevalence, risk factors and women’s symptoms after an injury. Furthermore women’s experiences of severe perineal trauma have been described. The aim of this study was to obtain a deeper understanding of the midwives’ experiences of attending a birth where the woman suffered a sphincter injury. Thirteen midwives were interviewed in three different delivery wards in Stockholm and Gothenburg. The essential structure of being a midwife when the woman suffers an obstetric anal sphincter injury during childbirth is to confront a truth, which is perceived as well known among midwives. This truth is that a skilled midwife can prevent severe perineal trauma. At the same time the midwife has to relate to a more complex belief, which implies that sphincter injuries cannot always be avoided no matter what the midwife does during the active phase of the second stage and the birth of the baby. When the midwives try to relate to both this accepted truth and the more complex belief at the same time they can find themselves in a deadlock, which is difficult to resolve. Being caught between an accepted truth and a more complex belief evoked various emotions among the midwives. Feelings of guilt, shame and the midwife’s own suspicion that she is not being professionally competent were not always easy to share. This study shows the importance of creating a safe working environment in which midwives can reflect on and share their experiences to continue to develop professionally.

References

Edqvist, M. Lindgren, H. Lundgren, I. (2014). Midwives’ lived experiences of a birth where the woman suffers an obstetric anal sphincter injury – a phenomenological study. BMC Pregnancy and Childbirth Aug 3;14(1):258. www.ncbi.nlm.nih.gov/pubmed/25086994

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