Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study

Background
Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries.
Aims
To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma.
Methods
A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson's chi-square test was used to measure association between birthing positions and perineal trauma.
Findings
Mothers, n = 94 (85%) and midwives, n = 108 (98%) reported high rates of lithotomy position for birth. N = 63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n = 65 (59%). However, a high majority of mothers, n = 106 (96%) and midwives, n = 97 (88%) reported they would be willing to use alternative positions. Majority of mothers had an episiotomy, n = 80 (73%) and n = 76 (69%) reported they did not give their consent. N = 59 (53%) reported they were not given local anaesthesia for an episiotomy. n = 30 (27%) of midwives confirmed they performed an episiotomy without local anaesthesia.
Conclusion
Care is not based on current evidence and embedded practices, i.e. birthing in lithotomy position and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt practice and consider different birthing positions and this may lead to fewer episiotomies being performed.