CARE OF THE PERINEUM IN THE 2ND-STAGE OF LABOR - A STUDY OF VIEWS ANDPRACTICES OF AUSTRALIAN MIDWIVES

Objectives: to seek the views of midwives on the practices related to the perineum in the second stage of labour; to identify predictors of their practices and to identify their actual practices in the second s tage of labour, prior to a randomised trial of second stage perineal m assage. Participants and setting: independent midwives in South Austra lia and 194 midwives working in the delivery suites and birth centres of seven public hospitals in four states of Australia. Design: midwive s were surveyed using a questionnaire which sought their views on, and practices relating to, second stage perineal massage, delivery of the head and reasons for cutting an episiotomy. Findings: one third of th e respondents 'never' practised perineal massage in the second stage o f labour, 43% were 'undecided' as to its value and 19% disagreed with the practice. Over half agreed that its use should be decided by the w oman and her partner. When invited to select the five statements they most agreed with, and the five they most disagreed with, out of a poss ible 24, equal numbers (26%) were for and against the statement referr ing to such massage as helping to stretch the perineum and prevent tea ring. More than half (55%) disagreed with the statement which predicte d they would find the practice distasteful, while only 1.6% agreed wit h this statement. During delivery of the head, 71% of respondents atte mpted some form of flexion. There was 100% agreement that fetal distre ss almost always or frequently was an indication for cutting an episio tomy. Conclusions: there is little evidence from randomised trials to support many of the second stage practices, and further research will clarify those which are most effective. This sample of midwives demons trated considerable variation in their views on, and practices in, the second stage of labour. Although one-fifth disagreed with the practic e of second stage perineal massage, and 40% agreed that the midwife sh ould decide, more than half (57%) believed it was a matter of choice f or the woman and her partner. All were supportive of episiotomy use fo r fetal distress.