Postnatal Perineal Wound Assessment

The Assessment of Postnatal Perineal Wound: Perspectives of Midwives and Women.

Around 85% of women who give birth vaginally experience a perineal wound, which could be a tear or an incision between the vaginal opening and the anus. Despite that, there is often insufficient exploration of how postnatal perineal wound assessment is conducted in healthcare research.

Clinical guidelines from the National Institute for Health and Care Excellence (NICE) touch on the typical signs of wound infection but do not offer detailed guidance on the execution of perineal assessment. Existing research evidence is mostly focused on long-term complications, management of perineal trauma immediately after birth or severe perineal trauma. The limited research on perineal wound care highlights how poor communication and information provision harm women at a physical and psychological level, negatively affecting daily tasks such as caring for their newborns.

Although there have been few studies examining women's or midwives' perspectives on perineal wound assessment in the context of uncomplicated wounds, their perspectives have never been jointly investigated to produce a comprehensive overview. Moreover, no research has had a clinical focus, investigating how the assessment is conducted in practice and what informs this practice, except from women's reports of perceived sub-standard care received.

Therefore, this proposed research is clinically grounded and aims to explore women's and midwives' perspectives on postnatal perineal wound assessment. This is needed to identify evidence-based practices, or lack thereof, in order to determine ways in which the experience can be improved for women and to have a more positive impact on their wellbeing.

Eight to ten pairs of midwives-women will be first observed whilst the routine assessment is conducted to understand what happens during this episode of care, and then they will be separately interviewed within a few days to gather further understanding. Recruitment will be in a single centre, which is a tertiary unit in the UK.

Study Overview

• Status: Recruiting
• Conditions: Perineum; Wound
• Intervention / Treatment: Other: Observation of postnatal wound assessment; Other: Interview

• Study Type: Observational
• Enrollment (Estimated): 20

Contacts and Locations

• Study Contact: Name: Giada Giusmin; Phone Number: 01865603166; Email: ggiusmin@brookes.ac.uk

Study Locations

• United Kingdom
  • Oxfordshire
    • Oxford, Oxfordshire, United Kingdom, OX39DU
      • Recruiting
      • Oxford University Hospital NHS Foundation Trust
      • Contact: Giada Giusmin; Phone Number: 01865603166; Email: ggiusmin@brookes.ac.uk

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Midwives and postnatal women

Description

Inclusion Criteria:

Midwives:

• NMC Registered midwives
• Working in the NHS
• Working in the community or postnatal ward
• Who assess perineal wounds

Women:

• Postnatal women who had a vaginal birth within the last ten days and had an uncomplicated perineal tear (first, second-degree or episiotomy).
• Had a healthy newborn (for example, the newborn is not currently admitted to newborn intensive care or the woman did not have a stillbirth)
• Located in the community or in hospital being cared for by midwives, within ten days postpartum when postnatal perineal wound assessment occurs.
• Over the age of 18, who can consent to participation
• English-speaking

Exclusion Criteria:

Midwives:

• Non-registered midwives and those working outside the NHS
• Who do not perform postnatal perineal wound assessment due to clinical settings or task restrictions.

Women:

• Who had a cesarean section
• Who had a stillbirth or fetal/neonatal complications
• Who had a vaginal birth but sustained severe perineal tears (third or fourth-degree tears)
• Who have not received NHS care or are outside standard postnatal locations
• Who are over 10 days postpartum at the time of perineal wound assessment
• Who are below the age of 18
• Non-English-speaking women

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Postnatal women	Other: Observation of postnatal wound assessment; Observation of postnatal wound assessment; Other: Interview; Interview to elicit individual perspectives of wound assessment
Registered midwives	Other: Observation of postnatal wound assessment; Observation of postnatal wound assessment; Other: Interview; Interview to elicit individual perspectives of wound assessment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Survey. How midwives conduct postnatal perineal wound assessment step-by-step.	10 days postnatal
Survey women's experiences of postnatal perineal wound assessment, i.e. emotional or physical discomfort.	10 days postnatal

Collaborators and Investigators

• Sponsor: Oxford Brookes University

Study record dates

Study Major Dates

• Study Start (Actual): November 20, 2024
• Primary Completion (Estimated): August 1, 2025
• Study Completion (Estimated): August 1, 2025

Study Registration Dates

• First Submitted: August 8, 2024
• First Submitted That Met QC Criteria: August 12, 2024
• First Posted (Actual): August 13, 2024

Study Record Updates

• Last Update Posted (Actual): August 8, 2025
• Last Update Submitted That Met QC Criteria: August 4, 2025
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries
• Other Study ID Numbers: 334946

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No