Optimising recovery after perineal trauma: Implementation of an evidence-based patient-centred care and clinical practice guideline

Marjan Khajehei; Julie Swain; Jennifer King; Collette Compton; Wandi Wei; Therese McGee; Seng Chai Chua; Beata Gidaszewski

doi:10.1016/j.wombi.2024.01.010

Optimising recovery after perineal trauma: Implementation of an evidence-based patient-centred care and clinical practice guideline

Women Birth. 2024 May;37(3):101584. doi: 10.1016/j.wombi.2024.01.010. Epub 2024 Feb 20.

Authors

Marjan Khajehei¹, Julie Swain², Jennifer King³, Collette Compton², Wandi Wei², Therese McGee⁴, Seng Chai Chua⁵, Beata Gidaszewski⁶

Affiliations

¹ Department of Women's and Newborn Health, Westmead Hospital, NSW 2145, Australia; University of New South Wales, Sydney, NSW 1466, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia; School of Nursing and Midwifery, Western Sydney University, NSW 2150, Australia. Electronic address: marjan.khajehei@sydney.edu.au.
² Department of Women's and Newborn Health, Westmead Hospital, NSW 2145, Australia.
³ Department of Women's and Newborn Health, Westmead Hospital, NSW 2145, Australia; Department of Urogynaecology, Westmead Hospital, Sydney, NSW 2145, Australia.
⁴ Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW 2145, Australia; Sydney Medical School Westmead, University of Sydney, Sydney, NSW 2006, Australia.
⁵ Department of Obstetrics and Gynaecology, Westmead Hospital, Sydney, NSW 2145, Australia; Sydney Medical School Westmead, University of Sydney, Sydney, NSW 2006, Australia; School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia.
⁶ Department of Women's and Newborn Health, Westmead Hospital, NSW 2145, Australia; Westmead Clinical School, University of Sydney, Sydney, NSW 2006, Australia.

PMID: 38378301
DOI: 10.1016/j.wombi.2024.01.010

Abstract

Background: Perineal trauma and pain can affect the quality of life of women who experience vaginal birth.

Aim: To investigate the effect of perineal care and pain management on women's postpartum recovery.

Methods: This was a Quasi-experimental study. In Phase 1 women were treated using our old postnatal perineal care management guideline. In Phase 2 an updated guideline was introduced (regular administration of icepacks and analgesia during the first 24-48 h postpartum). During Phase 1, pregnant women planning a vaginal birth completed a baseline questionnaire. Those who sustained perineal trauma completed a survey at 24-48 h, seven days and 12 weeks after birth. In Phase 2 we continued recruiting participants, using the same procedure, and investigated the efficacy of pain relief approaches using the new guideline.

Results: In Phase 1, 111 women (Group 1), and Phase 2, 146 women (Group 2) were recruited. No statistically significant differences were found between the two groups in terms of the women's pain catastrophising, their partner's responses to pain behaviours, or birth outcomes. At 24-48 h and seven days postpartum, women in Group 2 were less likely than women in Group 1 to be bothered by back or perineal pain, headache, sleeping difficulties and dizziness (p < 0.05). More women in Group 2 received regular paracetamol and perineal icepacks during their hospital stay, with less use of oxycodone in Group 2 than Group 1.

Conclusion: The implementation of the guideline's recommendations was associated with decrease back and perineal pain, headache, sleeping difficulties and dizziness during the first seven days postpartum.

Keywords: Childbirth; Medication; Pain; Perineal trauma.

MeSH terms

Dizziness*
Episiotomy / adverse effects
Female
Headache
Humans
Pain
Perineum / injuries
Postpartum Period
Pregnancy
Quality of Life*