Prevention and Management of Severe Obstetric Anal Sphincter Injuries (OASIs): a National Survey of Nurse- Midwives
- 12 Downloads
Introduction and hypothesis
There are no data on midwives’ knowledge and management of obstetric anal sphincter injuries (OASIs) in the USA. We performed a cross-sectional national survey characterizing OASI practice by certified nurse midwives (CNMs), hypothesizing that few midwives personally repair OASIs and that there are gaps in CNM OASI training/education.
We emailed a REDCap internet-based survey to 6909 American College of Nurse Midwives members (ACNM). We analyzed responses from active clinicians performing at least one delivery per month, asking about OASI risks, prevention, repair, and management. We summarized descriptive data then evaluated OASI knowledge by patient and provider characteristics.
We received 1070 (15.5%) completed surveys, and 832 (77.8%) met the inclusion/exclusion criteria. Participants were similar to ACNM membership. Respondents most frequently identified prior OASI (87%) and nutrition (71%) as antepartum OASI risk factors and, less frequently, nulliparity (36%) and race (22%). Identified intrapartum risks included forceps delivery (94%) and midline episiotomy (88%). When obstetric laceration is suspected, 13.6% of respondents perform a rectal examination routinely. Only 15% of participants personally perform OASI repair. Overall, participants matched 64% of evidence-based answers. OASI education/training courses were attended by 30% of respondents, and 44% knew of OASI protocols within their group/institution. Of all factors evaluated, the percent of evidence-based responses was only different for respondent education/CME and protocols.
Quality initiatives regarding OASI prevention and management may improve care. Our data suggest OASI training for midwives may improve delivery care in the US. Further studies of other obstetric providers are needed.
KeywordsCross-sectional Education Midwifery OASIs Perineal trauma Quality improvement
We acknowledge Andre Owens for his assistance implementing the invitations and Nicole Carlson, CNM, PhD, for her input on project design and the consensus process. We especially thank all the participants from ACNM without whom we could not have done this work.
This work was supported by the Rocky Vista University College of Osteopathic Medicine Intramural Research Grant (SD), the Department of Obstetrics and Gynecology (KJH), the Society of Family Planning Junior Investigator Career Grant SFPRF10-JI1 (MG), and the NIH/NCRR Colorado CTSI grant no. UL1 RR025780 (RedCap resource). Its contents are the authors’ sole responsibility and do not necessarily represent official UC Denver, Rocky Vista University, or NIH views.
Compliance with ethical standards
Financial disclaimer/conflict of interest
- 7.Hamilton BE MJ, Osterman MJK, Curtin, SC, Mathews TJ (2015) Births: Final Data for 2014. National Center for Health Statistics. http://www.midwife.org/CNM/CM-attended-Birth-Statistics. Accessed Sept 4 2018.
- 8.Bick DE, Ismail KM, Macdonald S, Thomas P, Tohill S, Kettle C. How good are we at implementing evidence to support the management of birth related perineal trauma? A UK wide survey of midwifery practice. BMC Pregnancy and Childbirth. 2012;12:57. https://doi.org/10.1186/1471-2393-12-57.CrossRefGoogle Scholar
- 10.Agency for Healthcare Research and Quality. Guide to Patient Safety Indicators. (2003) US Department of Health and Human Services http://www.qualityindicators.ahrq.gov/downloads/modules/psi/v31/psi_guide_v31.pdf. Accessed September 15 2018.
- 11.Agency for Healthcare Research and Quality. (2014) US Department of Health and Human Services https://nhqrnet.ahrq.gov/inhqrdr/data/submit. Accessed June 6 2018.
- 12.Colorado Hospital Quality Report by Measure (2016). http://www.cohospitalquality.org:8080/corda/dashboards/COLORADO_REPORT_CARD_BY_MEASURE/main.dashxml-cordaDash=1060. Accessed May 20 2018.
- 17.ACNM Essential Facts About Midwives. American College of Nurse-Midwives http://www.midwife.org/Essential-Facts-about-Midwives. Accessed June 1 2018.
- 18.IIBM Corp. Released. BM SPSS statistics for windows, version 24.0. Armonk, NY: IBM Corp; 2016.Google Scholar
- 23.Core Competencies for Basic Midwifery Practice (2012) American College of Nurse-Midwives http://www.midwife.org/ACNM/files/ACNMLibraryData/UPLOADFILENAME/000000000050/Core Comptencies Dec 2012.pdf. Accessed Oct 29 2018.
- 24.Agency for Healthcare Research and Quality. PSI 18 and 19: Obstetric Trauma Rate – Vaginal Delivery With and Without Instrument. http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/d4k-laceration-bestpractices.pdf. Accessed March 30 2016.
- 25.Basu M, Smith D. Long-term outcomes of the stop traumatic OASI morbidity project (STOMP). Int J Gynaecol Obstet. 2018. https://doi.org/10.1002/ijgo.12565.
- 27.Mascarello KC (2017) Maternal complications and cesarean section without indication: systematic review and meta-analysis. 51. https://doi.org/10.11606/s1518-8787.2017051000389.
- 30.Burton SJ, Sudweeks RR, Merrill PF, Wood B (1991) How to Prepare Better Multiple-Choice Test Items: Guidelines for University Faculty. Brigham Young University Testing Services.Google Scholar