title: The decision to suture after childbirth: cues, related factors, knowledge and experience used by midwives.
abstract: OBJECTIVE
  to present critical cues, related factors, knowledge and experience used by midwives when deciding whether or not to suture perineal and associated trauma after childbirth.
  
  
  METHODS
  an exploratory descriptive study using in-depth interviews to collect data using the Critical Decision Method.
  
  
  METHODS
  birth units in Greater Western Sydney.
  
  
  METHODS
  19 volunteer midwives experienced in deciding whether or not to suture or in making referrals to suture childbirth trauma.
  
  
  RESULTS
  the main findings were the cues of bleeding and trauma with their accompanying specific attributes, and woman- and midwife-centred factors considered when deciding whether or not to suture perineal and associated trauma. Furthermore, the knowledge and experience that supported decision-making, such as detailed knowledge of anatomical structures, workshops and observing highly skilled clinicians, were identified.
  
  
  CONCLUSIONS
  the cues and related factors can be formed into an inventory and tested for content validity using a panel of expert midwives.
  
  
  CONCLUSIONS
  such an inventory has the potential to minimise inappropriate intervention and alleviate unnecessary discomfort, thus increasing safety and quality of care for women following childbirth. In addition, midwifery educators and those coaching less-experienced midwives can use the collected clinical information to aid the development of students' and midwives' decision-making skills regarding whether or not to suture childbirth trauma.
authors.affiliation: School of Nursing, University of Western Sydney, Locked Bag 1797, Penrith South DC NSW 1797, Australia. j.cioffi@uws.edu.au
authors.forename: Jane M
authors.initials: JM
authors.lastname: Cioffi
authors.forename: Julie
authors.initials: J
authors.lastname: Swain
authors.forename: Fiona
authors.initials: F
authors.lastname: Arundell
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D022125:Lacerations / Q000451:nursing*; D008880:Midwifery / Q000193:education / Q000379:methods*; D009517:New South Wales; D024802:Nurse's Role; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011644:Puerperal Disorders / Q000451:nursing; D011785:Quality Assurance, Health Care; D013536:Suture Techniques / Q000451:nursing*; D055815:Young Adult