Graduation Year
2022
Document Type
Senior Thesis
Degree
Bachelor of Science in Nursing
Primary Major
Nursing
Primary Minor
Global Public Health
Thesis Advisor
Patricia Harris, PhD, RN, CNS
Abstract
Background
Perineal lacerations are a common occurrence in childbirth- with tears occurring in 53-79% of women. Trauma to the perineum is classified into 4 categories, with each class increasing in severity. Severe perineal lacerations have long term consequences for the women who experience them.
Objectives
To compare the effectiveness of methods which aim to reduce the rate and severity of perineal lacerations, including: hands on vs hands off technique, slow and controlled birth, use of lubrication, perineal massage, etc.
Summary of Findings
The literature review suggests that it is critical to employ methods to reduce laceration incidence and severity as the consequences of lacerations- specifically third and fourth degree lacerations- include anal incontinence, weaker pelvic floor muscles, perineal pain, and poorer sexual function. Evidence suggests that intact perineum incidence increases with the following techniques: use of a warm compress, perineal massage, use of a perineal protection device, breathing the head out, and employing a kneeling or lateral position for the second stage. Mixed evidence was found on the use of a hands on technique to support the perineum.
Proposal
As evidenced by this literature review, mixed results were found on the use of a hands on vs hands off techniques in protection of the perineum. To form a consensus on the benefits or harm of this practice, additional randomized controlled trials should be conducted.