Interprofessional care management of perineal injuries by physiotherapists and midwives after childbirth - a qualitative study

Hypothesis / aims of study
The management of obstetric anal sphincter injuries presents a significant challenge in postpartum care. Approximately 2.2% of women in Austria who are giving birth suffer from such an injury each year (1). As a result, perineal pain, flatus and anal incontinence, or sexual dysfunction may occur. To provide the best possible care and ideally prevent any of these consequences during the postpartum period and beyond, a care management system that involves various professional groups is required (2). The aim of the study is to identify how physiotherapists and midwives take part in the management of perineal injuries and how they include interprofessional communication and teamwork in their daily practice.
Study design, materials and methods
For this study, expert interviews based on a semi-structured interview guideline were conducted to explore the dynamics of interprofessional collaboration in the management of perineal lacerations. The nine participants were recruited through professional association websites and social media. Physiotherapists and midwives who work in the freelance sector and have at least one year of professional experience were included in this study. One of the main target groups should be women postpartum for postnatal care and recovery. The interviews took place in March 2024, either in person or online, in both cases, they were recorded and transcribed in the next step. To analyze the data, categories were specified using the deductive category formation method. These domains included the topics first contact and duration of the care period, anamnesis and medical report, therapy, recommendations for further deliveries, limitations of one’s own practice and interprofessional collaboration. This classification is based on the current german, austrian and swiss guideline on the management of perineal lacerations stage III and IV. During the data analyzing process subcategories were added in order to better structure the participants’ statements.
Results
Within the previous defined categories, domains were identified where the interprofessional collaboration already exists, or where such teamwork would be appropriate. Those aspects included transmitting information regarding patient history, examination and treatment strategies and managing births and educating patients about treatment options (see figure).
It was also found that regular contact between the groups does not exist in all cases, but the importance of this cooperation for an adequate care of women during the postpartum period was emphasized by each expert. One of the major obstacles identified was that, in most cases, the periods of care do not overlap. For instance, midwives typically provide care during the first eight weeks postpartum, while women start with physical therapy at week six to eight. The findings highlight distinct roles for physiotherapists and midwives in the management of perineal lacerations, each contributing to the overarching goal of optimal patient care. Physiotherapists are instrumental in providing rehabilitative interventions aimed at pelvic floor muscle function and perineal healing, whereas midwives focus upon obstetric care and immediate postpartum support. However, recognizing the limitations of one’s own profession and having the opportunity to refer to more specialized professional groups is necessary in order to ensure optimal care.
Interpretation of results
The results show the need of establishing scenarios where interprofessional exchanges are possible. The lack of communication between health professionals has already been mentioned before in the study of Gustavsson an Eriksson-Cromment (3). They also stated that the teamwork between physiotherapists and midwives leads to a more evidence based practice regarding postpartum care. Therefore, a culture of interprofessional collaboration where communication concerning the different treatment strategies is established could be a future goal in the care management of women with perineal lacerations.
This study shows some limitations as the small amount of participants represents only a few opinions on this topic. Another constraint of the study is that the author herself did the interviews and the interpretation, which could have led to some sort of subjective evaluation.
Concluding message
In conclusion, effective collaboration between physiotherapists and midwives is essential for optimizing postpartum care and mitigating the risks associated with obstetric anal sphincter injuries. By recognizing the distinct yet complementary roles of each profession and fostering interdisciplinary communication and coordination, healthcare providers can ensure holistic care for women during the postpartum period and beyond.
Figure 1categories and results
References
Delmarko, I., Leitner, H., Neururer, S., & Harrasser, L. (2022). Geburtenregister Österreich. Bericht über die Geburtshilfe in Österreich 2020. https://www.iet.at/data.cfm?vpath=publikationen210/groe/groe-jahresbericht-2020
Green, B. N., & Johnson, C. D. (2015). Interprofessional collaboration in research, education, and clinical practice: working together for a better future. J Chiropr Educ, 29(1), 1-10. https://meridian.allenpress.com/jce/article/29/1/1/131206/Interprofessional-collaboration-in-research
Gustavsson, C., & Eriksson-Crommert, M. (2020). Physiotherapists' and midwives' views of increased inter recti abdominis distance and its management in women after childbirth. BMC Womens Health, 20(1), 37. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-00907-9