Background: Severe perineal trauma (SPT) (third or fourth degree tears) sustained during vaginal birth, is associated with short and long term physical and psychological morbidities for women. Research conducted nationally and internationally indicates that the incidence of SPT is increasing, which is associated with increased rates of SPT and improved recognition and reporting by health professionals. However despite this, research on women's experiences of SPT is limited, and the adequacy of support and health services available to women following SPT has not been examined. Developing an understanding of women's experiences of SPT, and the current health services provided and accessed, will assist health professionals in the provision of appropriate models of care. This thesis is presented as a series of four published papers, and one paper currently under review. The findings of these studies contribute towards an understanding of women's experiences following SPT. Aim: The aim of this mixed methods study was to understand the experiences of women who have sustained severe perineal trauma (3rd and 4th degree perineal tears) and associated morbidities, and to investigate health service provision across NSW, Australia. This study had four objectives: 1) To describe the physical health, psychological, and social experiences for women who have sustained SPT; 2) To determine if there has been a change in the incidence of SPT in NSW over the past 10 years, and to identify the factors associated with SPT and the impact SPT has on subsequent modes of birth; 3) To describe the health services available for women who experience SPT in NSW; and 4) To provide an integrated analysis of the data to outline best practice to inform services for women. Methods: This study used a sequential concurrent mixed methods design. A transformative-emancipatory auto-ethnographic approach was incorporated into the design, analysis and preparation of the study as the author identified with the group under investigation following a personal experience of SPT and associated long term morbidities. Findings: the central and key finding of this mixed methods study is represented by 'The Abandoned Mother' concept. It appears that, despite the long term psychological and physical morbidities experienced by women who sustain SPT, there is a lack of guidelines, policies and services specific to the care of women following SPT. This needs to be addressed as a matter of urgency. Women who experience SPT seek compassionate and supportive care based upon a clear exchange of information, and this should be considered when reflecting upon the current health service design. This study highlights the urgent need to establish specialist services across NSW that are comprehensive, collaborative and multi-disciplinary to support women who experience SPT and associated morbidities, with the aim of providing consistency in best practice and comprehensive physiological and psychological support.
Date of Award | 2014 |
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Original language | English |
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- perineum
- wounds and injuries
- surgery
- childbirth
- episiotomy
- New South Wales
Experiences of women who have severe perineal trauma, their associated morbidity and health service provision in New South Wales, Australia : a mixed methods study
Priddis, H. (Author). 2014
Western Sydney University thesis: Doctoral thesis