title: Perineal management techniques among midwives at five hospitals in New South Wales - a cross-sectional survey.
abstract: BACKGROUND
  Midwives are reported to have changed from 'hands on' to 'hands poised or off' approaches to birth at the same time as obstetric anal sphincter injuries (OASIs) are increasing. As perineal management details are not routinely collected, it is difficult to quantify practice.
  
  
  OBJECTIVE
  To determine which perineal protections techniques midwives prefer for low-risk non-water births; whether preference is associated with technique taught or with other characteristics; and whether midwives change preference according to clinical scenario.
  
  
  METHODS
  Midwives in Northern Sydney Local Health District (NSLHD) were surveyed during a 2-week period in 2014. Multiple-choice questions were used, with free text option. Descriptive analyses, chi-square and McNemar tests were undertaken.
  
  
  RESULTS
  One hundred and eight midwives participated (response rate 76.7%). 'Hands poised or off' was preferred by 63.0% for a low-risk birth. Current practice was associated with technique taught (P < 0.01). For scenarios with increased OASI risk midwives reported switching to 'hands on', with 83.4% employing 'hands on' whether there was concern about an impending OASI. There has been a shift over time from teaching 'hands on' to 'hands poised or off'.
  
  
  CONCLUSIONS
  The preferred technique for a low-risk birth appears to have changed from 'hands on' to 'hands poised or off', but most midwives adopt 'hands on' in situations of high risk for OASI. Further research is needed to establish whether there is an association with the rising OASI rate and the change in preferred perineal management technique for a low-risk birth.
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Ampt
authors.affiliation: North Shore Ryde Health Service, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: de Vroome
authors.affiliation: Clinical and Population Perinatal Health Research, Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: Jane B
authors.initials: JB
authors.lastname: Ford
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries*; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000517:prevention & control*; D008875:Middle Aged; D008880:Midwifery / Q000193:education / Q000379:methods*; D009517:New South Wales; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D010502:Perineum / Q000293:injuries*; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: midwifery survey; obstetric anal sphincter injury; perineum; ‘hands off or poised’; ‘hands on’