title: Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study.
abstract: BACKGROUND
  Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries.
  
  
  OBJECTIVE
  To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma.
  
  
  METHODS
  A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson's chi-square test was used to measure association between birthing positions and perineal trauma.
  
  
  RESULTS
  Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, n=106 (96%) and midwives, n=97 (88%) reported they would be willing to use alternative positions. Majority of mothers had an episiotomy, n=80 (73%) and n=76 (69%) reported they did not give their consent. N=59 (53%) reported they were not given local anaesthesia for an episiotomy. n=30 (27%) of midwives confirmed they performed an episiotomy without local anaesthesia.
  
  
  CONCLUSIONS
  Care is not based on current evidence and embedded practices, i.e. birthing in lithotomy position and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt practice and consider different birthing positions and this may lead to fewer episiotomies being performed.
authors.affiliation: Department of Nursing Science, University of Port Harcourt, Nigeria. Electronic address: faith.diorgu@uniport.edu.ng.
authors.forename: Faith C
authors.initials: FC
authors.lastname: Diorgu
authors.affiliation: School of Nursing & Midwifery, University of South Australia (UniSA), Adelaide, SA 5000, Australia. Electronic address: mary.steen@unisa.edu.au.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Steen
authors.affiliation: Faculty of Health and Social Care/Faculty of Medicine, Dentistry and Clinical Sciences, University of Chester, United Kingdom. Electronic address: j.keeling@chester.ac.uk.
authors.forename: June J
authors.initials: JJ
authors.lastname: Keeling
authors.affiliation: Dental and Inter-Professional Education, Faculty of Health and Social Care/Faculty of Medicine, Dentistry and Clinical Sciences, University of Chester, United Kingdom. Electronic address: e.whitehead@chester.ac.uk.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mason-Whitehead
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods*; D004841:Episiotomy / Q000009:adverse effects; D005260:Female; D006306:Health Surveys; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery; D009035:Mothers; D009721:Nurse Midwives; D036801:Parturition; D010465:Perception; D010502:Perineum / Q000293:injuries* / Q000601:surgery; D011187:Posture; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Birthing position; Childbirth; Midwives; Mothers; Perineal trauma