The risk of perineal trauma during childbirth continues to affect approximately 85% of women, of these, 60-70% will require suturing (McLandish et al. 1988, Bick et al. 2010). Inadequate perineal repair is associated with short and long term physical and psychological problems for the woman, including: pain on micturition; defecations and exercise; urinary and less frequently faecal incontinence; dyspareunia; wound infection and wound breakdown (Brimacombe 1995). Two of the key factors influencing the outcome of perineal repair are the skill of the person performing the procedure and the suturing technique they employ (Brimacombe 1995). There is a general consensus that midwives, as key care providers at birth are best positioned to perform perineal repair (Mutema 2007, NICE 2007). Confidence and competence in undertaking perineal repair is a skill which is essential for midwives, if women are to be offered a greater choice of midwifery led models of care.
The philosophy of this programme takes cognisance that midwives and nurses are required to work under the guidance of the NMBI and within their scope of practice in order to provide safe, quality care to women and their babies.
In the Centre for Midwifery Education we commit to an andragogical approach to learning in which proactivity, enquiry and autonomy feature predominantly (Quinn 2013). As a result we acknowledge that programme participants are adult learners with existing knowledge and a wealth of experience and therefore utilise teaching strategies that encourage reflection dialogue and debate.
Value is placed on the experience, expertise and ability of programme facilitators to impart evidence based knowledge in relation to breast feeding.
The aim of this programme is to equip midwives with the knowledge and skill for them to proceed to gain competence and/or remain competent in perineal repair.
On completion of this programme it is anticipated that attendees will:
- Demonstrate knowledge and understanding of the anatomy and physiology and the functions of the pelvic floor
- Critically discuss evidence in relation to protecting the perineum during childbirth
- Be able to classify perineal trauma
- Describe the role of the nurse and midwife in undertaking the skill of perineal repair
- Proceed to successfully complete the supervised practice assessments and the final competence assessment
- Practice independently and maintain competence in accordance with scope of practice and local policy
- Anatomy and physiology of the pelvic floor
- Assessing and classification of perineal trauma
- Evidence relating to protecting the perineum and suturing techniques
- Infection control and clinical risk issues
- Simulated workshop for demonstration and practice.