Patient and provider attitudes toward perineal injury prevention techniques for vaginal birth: A qualitative study

OBJECTIVE: We aimed to understand motivation and barriers for engaging in perineal trauma-reducing interventions for childbirth including antenatal perineal massage, warm compress use, and selective episiotomy. METHODS: In this qualitative study, we recruited patients over 34 weeks gestational age planning vaginal birth and birthing care providers. Semi-structured, one-on-one interviews were completed to data saturation. A constructivist approach to thematic analysis was used to analyze interviews. A coding frame was created following independent review of a subset of interviews and used to code interviews and develop themes. RESULTS: Fifteen patients and ten providers were included in the analysis. Motivation for adoption of perineal protection methods included perceived ease of recovery, fear of perineal injury, body awareness and personal experience, in addition to provider and community guidance. Barriers for use of common methods to mitigate risk of tearing were classified into three major themes: psychologic, physical, and social. Psychologic subthemes included fear, knowledge (including belief of minimal benefit), mental barriers, and motivational disengagement. Physical subthemes included structural access, physical discomfort, time constraints, and resources. Social subtheme barriers included autonomy, provider distrust, communication, and taboo. Episiotomy was noted as a controversial intervention by both providers and patients over concern for respect of patient autonomy. CONCLUSION: Provider guidance was a key motivator for adoption of techniques to reduce perineal trauma at vaginal birth. Future strategies for prevention of perineal trauma at vaginal birth may focus on mitigating common barriers to engaging in low-risk interventions.