Does midwife experience affect the rate of severe perineal tears?

Birth. 2017 Jun;44(2):161-166. doi: 10.1111/birt.12278. Epub 2017 Feb 15.


Background: Our aim was to study whether midwife experience affects the rate of severe perineal tears (3rd and 4th degree).

Methods: A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. Exclusion criteria were instrumental deliveries and stillbirth. All midwives used a "hands on" technique for protecting the perineum. The midwife experience at each delivery was calculated as the time interval between her first delivery and current delivery. A comparison was performed between deliveries in which midwife experience was less than 2 years (inexperienced), between 2 and 10 years (moderately experienced), and more than 10 years (highly experienced). A multivariate regression analysis was performed to assess the association between midwife experience and the incidence of severe perineal tears, after controlling for confounders.

Results: Overall, 15 146 deliveries were included. Severe perineal tears were diagnosed in 51 (0.33%) deliveries. Women delivered by inexperienced midwives had a higher rate of severe perineal tears compared with women delivered by highly experienced midwives (0.5% vs 0.2%, respectively, P=.024). On multivariate regression analysis, midwife experience was independently associated with a lower rate of severe perineal tears, after controlling for confounding factors. Each additional year of experience was associated with a 4.7% decrease in the risk of severe perineal tears (adjusted OR 0.95 [95% CI 0.91-0.99, P=.03).

Conclusion: More experienced midwives had a lower rate of severe perineal tears, and may be preferred for managing deliveries of women at high risk for such tears.

Keywords: OASIS; midwives; obstetric lacerations; perineal tears.

MeSH terms

  • Adult
  • Anal Canal / injuries
  • Clinical Competence
  • Episiotomy / adverse effects*
  • Female
  • Humans
  • Incidence
  • Injury Severity Score
  • Israel / epidemiology
  • Lacerations / epidemiology*
  • Lacerations / etiology
  • Logistic Models
  • Midwifery / standards*
  • Multivariate Analysis
  • Obstetric Labor Complications / epidemiology*
  • Obstetric Labor Complications / etiology
  • Parity
  • Perineum / injuries*
  • Pregnancy
  • Retrospective Studies
  • Risk Factors
  • Tertiary Care Centers
  • Young Adult