title: Does midwife experience affect the rate of severe perineal tears?
abstract: Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree).
  
  
  
  A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders.
  
  
  
  Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91-0.99, P=.03).
  
  
  
  More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yossi
authors.identifier: 0000-0002-2533-6972
authors.initials: Y
authors.lastname: Mizrachi
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sophia
authors.initials: S
authors.lastname: Leytes
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Levy
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Zvia
authors.initials: Z
authors.lastname: Hiaev
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shimon
authors.identifier: 0000-0002-2995-7194
authors.initials: S
authors.lastname: Ginath
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bar
authors.affiliation: Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Kovo
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000293:injuries; D002983:Clinical Competence; D004841:Episiotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007557:Israel / Q000453:epidemiology; D022125:Lacerations / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008880:Midwifery / Q000592:standards*; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology* / Q000209:etiology; D010298:Parity; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: 
  OASIS
  ; midwives; obstetric lacerations; perineal tears