What is known about the experiences of women receiving hands-on perineal interventions in the second stage of labour – a scoping review

Background: Perineal damage affects 77 per cent of Australian women birthing vaginally with many women perceiving this as an expected outcome of vaginal birth. Evidence regarding effective interventions in the second stage of labour for reducing perineal damage is lacking. There is also some disagreement about appropriate methods of providing perineal care in the second stage of labour. The quantitative nature of current evidence regarding perineal care in labour undervalues women’s psychosocial health which may have negative impacts on women’s experiences.

Aim: To determine the scope and nature of evidence regarding perineal care in the second stage of labour.

Methods: A scoping review was conducted using Arksey and O’Malley’s (2005) five-step framework whereby the review question was identified, relevant studies sourced and selected and data charted and synthesised. Systematic and replicable searches of the Cochrane Database of Systematic Reviews, CINAHL Complete, MEDLINE, PsycInfo, MIDIRS Maternity & Infant Care (MIC) database, Google Scholar, Google and NICE guidance were performed using combinations of key words related to the review aim in combination with Boolean operators AND and OR. A scoping review methodology allowed for the inclusion of both published and grey literature, including clinical guidelines.

Findings: The initial search resulted in 344 hits, with 341 accessed and found not to meet inclusion criteria. Google provided a further 14 hits. The literature search resulted in four articles consistent with the review criteria. As this is a scoping review, formal critical appraisal was not conducted, however a PRISMA charting exercise was performed to ensure pertinent information in each data source was accurately identified. Australian and international literature were included, giving a global perspective, and both qualitative and quantitative data were included. Analysis of data from sources retained for review highlights a maternity care culture which values the physiological outcomes of birth, while paying little attention to the potential psychosocial implications of hands-on perineal interventions, such as manual perineal support and the use of warm compresses.

Conclusions: Future research investigating women’s views about, experiences of, and preferences regarding intimate aspects of birth care is required to better inform clinical practice guidelines. Further education pertaining to the provision of trauma and violence informed care (TVIC) may be of benefit to maternity care providers.