title: Midwives' lived experience of a birth where the woman suffers an obstetric anal sphincter injury--a phenomenological study.
abstract: BACKGROUND
  The occurrence of obstetric anal sphincter injuries (OASIS) has increased in most high-income countries during the past twenty years. The consequences of these injuries can be devastating for women and have an impact on their daily life and quality of health. The aim of this study was to obtain a deeper understanding of midwives' lived experiences of attending a birth in which the woman gets an obstetric anal sphincter injury.
  
  
  METHODS
  A qualitative study using phenomenological lifeworld research design. The data were collected through in-depth interviews with 13 midwives.
  
  
  RESULTS
  The essential meaning of the phenomenon was expressed as a deadlock difficult to resolve between a perceived truth among midwives that a skilled midwife can prevent severe perineal trauma and at the same time a coexisting more complex belief. The more complex belief is that sphincter injuries cannot always be avoided. The midwives tried to cope with their feelings of guilt and wanted to find reasons why the injury occurred. A fear of being exposed and judged by others as severely as they judged themselves hindered the midwives from sharing their experience. Ultimately the midwives accepted that the injury had occurred and moved on without any definite answers.
  
  
  CONCLUSIONS
  Being caught between an accepted truth and a more complex belief evoked various emotions among the midwives. Feelings of guilt, shame and the midwife's own suspicion that she is not being professionally competent were not always easy to share. This study shows the importance of creating a safe working environment in which midwives can reflect on and share their experiences to continue to develop professionally. Further research is needed to implement and evaluate the effect of reflective practices in relation to midwifery care and whether this could benefit women in childbirth.
authors.affiliation: Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Arvid Vallgrens backe hus 1, Box 457, 405 30 Gothenburg, Sweden. malin.edqvist@gu.se.
authors.forename: Malin
authors.initials: M
authors.lastname: Edqvist
authors.forename: Helena
authors.initials: H
authors.lastname: Lindgren
authors.forename: Ingela
authors.initials: I
authors.lastname: Lundgren
mesh_terms: D000223:Adaptation, Psychological; D001003:Anal Canal / Q000293:injuries*; D005239:Fear; D005260:Female; D006167:Guilt; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D022125:Lacerations / Q000517:prevention & control / Q000523:psychology; D008880:Midwifery; D036801:Parturition; D036301:Qualitative Research; D013315:Stress, Psychological / Q000209:etiology*
references.citation: Clin Chim Acta. 2009 Jun;404(1):2-5
references.pmid: 19302989
references.citation: J Adv Nurs. 2013 Apr;69(4):748-59
references.pmid: 23057716
references.citation: Eur J Obstet Gynecol Reprod Biol. 2008 Apr;137(2):152-6
references.pmid: 17681663
references.citation: Midwifery. 2005 Sep;21(3):253-66
references.pmid: 15967549
references.citation: Midwifery. 2008 Jun;24(2):132-7
references.pmid: 18378051
references.citation: Acta Obstet Gynecol Scand. 2002 Jan;81(1):44-9
references.pmid: 11942886
references.citation: J Adv Nurs. 1999 Sep;30(3):732-9
references.pmid: 10499231
references.citation: BJOG. 2011 May;118(6):662-70
references.pmid: 21392242
references.citation: Birth. 1992 Mar;19(1):10-8; discussion 19-20
references.pmid: 1558581
references.citation: Midwifery. 2011 Jun;27(3):331-5
references.pmid: 21458894
references.citation: BJOG. 2000 Jul;107(7):926-31
references.pmid: 10901566
references.citation: BMJ. 1994 Apr 2;308(6933):887-91
references.pmid: 8173367
references.citation: Accid Emerg Nurs. 2004 Oct;12(4):215-23
references.pmid: 15474346
references.citation: Birth. 2008 Jun;35(2):98-106
references.pmid: 18507580
references.citation: Acta Obstet Gynecol Scand. 1998 Nov;77(10):974-7
references.pmid: 9849840
references.citation: Cochrane Database Syst Rev. 2011 Dec 07;(12):CD006672
references.pmid: 22161407
references.citation: Cochrane Database Syst Rev. 2013 Jan 31;(1):CD008070
references.pmid: 23440824
references.citation: BJOG. 2007 Oct;114(10):1266-72
references.pmid: 17877679
references.citation: BMC Pregnancy Childbirth. 2011 Mar 24;11:22
references.pmid: 21435238