Research Article|Articles in Press

Putting evidence into practice: A quality activity of proactive pain relief for postpartum perineal pain

  • Author Footnotes
    1 Tel.: +61 02 9685 9118; fax: +61 9881 7618.
    J. Swain
    1 Tel.: +61 02 9685 9118; fax: +61 9881 7618.
    Blacktown Hospital, Blacktown Rd, Blacktown, NSW 2148, Australia
    Search for articles by this author
  • H.G. Dahlen
    Corresponding author. Tel.: +61 9881 7690; fax: +61 02 9685 9599.
    School of Nursing and Midwifery, College of Health and Science, University of Western Sydney, Building ER, Parramatta Campus, Locked Bag 1797, Penrith South DC, NSW 1797, Australia
    Search for articles by this author
  • Author Footnotes
    1 Tel.: +61 02 9685 9118; fax: +61 9881 7618.



      Perineal pain associated with perineal trauma is often underestimated. Offering regular pain relief may be advantageous compared to waiting for women to request it. Changing clinical practice in a sustained way needs a whole of team approach.


      To reduce women's pain following perineal trauma in the first 48 h following childbirth and to undertake this as multidisciplinary, quality activity.


      In November 2008 a questionnaire was distributed to 18 new mothers who had sustained perineal trauma during the birth in order to assess pain levels in the first 48 h and to investigate pain management therapies used. Following this survey a multidisciplinary project team undertook a series of brainstorming sessions, reviewed the literature and undertook staff surveys to identify key factors impacting on women's perineal pain. A process of decision making led to education and support of women and staff. An evidence based guideline, which involved prescribing regular pain relief for women and offering an ice pack within 1 h of giving birth was implemented, and a brochure was designed for women. A follow up questionnaire was distributed in June 2010 to 18 women and pain scores before and after the change in policy were compared.


      Prior to the practice change in 2008 67% of the women surveyed rated their pain as ‘moderate’ to ‘a lot’ 48 h following the birth. Following the change in practice and implementation of a new guideline a second survey in 2010 at 48 h postpartum found 60% of women in the post intervention group rated their perineal pain as ‘a lot’ to ‘moderate’. There had been a 33% increase in women's use of pain relief options compared to the pre-intervention survey. The practice change was sustained and adopted by all the staff.


      By taking a multidisciplinary quality activity an effective practice change was facilitated that appeared to decrease women's perineal pain in the 48 h following birth.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Dahlen H.
        Perineal care and repair.
        in: Pairman S. Tracy S. Thoroughgood C. Midwifery preparation for practice 2e. Churchill Livingstone Elsevier, Sydney2010: 543-563
        • Dahlen H.
        • Homer C.
        Perineal trauma and postpartum perineal morbidity in Asian and non-Asian primiparous women.
        JOGNN-Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2008; 37: 455-463
        • Sleep J.
        • Grant A.
        West Berkshire perineal management trial: three-year follow-up.
        British Medical Journal. 1987; 295: 749-751
        • Glazener C.
        • Adballa M.
        • Stroud P.
        Postnatal maternal morbidity: extent, causes, prevention and treatment.
        British Journal of Obstetrics and Gynaecology. 1995; 102: 282-287
        • McCandlish R.
        • Bowler U.
        • van Asten H.
        • Berridge G.
        • Winter C.
        • Sames L.
        • et al.
        A randomised controlled trial of care of the perineum during second stage of normal labour.
        British Journal of Obstetrics and Gynaecology. 1998; 105: 1262-1272
        • Kenyon S.
        • Ford F.
        How can we improve women's postbirth perineal health?.
        MIDIRS Midwifery Digest. 2004; 14: 7-12
        • Albers L.
        • Garcia J.
        • Renfrew M.
        • McCandlish R.
        • Elbourne D.
        Distribution of genital tract trauma in childbirth and related postnatal pain.
        Birth. 1999; 26: 11-15
        • Klein M.C.
        • Gauthier R.J.
        • Robbins J.M.
        • Kaczorowski J.
        • Jorgensen S.H.
        • Franco E.D.
        Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation.
        Journal of Obstetrics and Gynecology. 1994; 45: 318-323
        • Macarthur A.J.
        • Macarthur C.
        Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study.
        American Journal of Obstetrics and Gynecology. 2004; 191: 119-204
        • Greenshields W.
        • Hulme H.
        A survey of women's experiences and midwive's practices.
        in: Oliver S. The perineum in childbirth. National Childbirth Trust, London1993
        • De Chateau P.
        • Winberg B.
        Long term effects on mother–infant behaviour of extra contact during the first hour postpartum. 11. A follow up at 3 months.
        Acta Paediatrica Scandinavica. 1977; 66: 144-151
        • Salariya E.M.
        • Easton P.M.
        • Cater J.L.
        Infant feeding: duration of breastfeeding after early initiation and frequent feeding.
        Lancet. 1978; 2: 1141-1143
        • Lundquist M.
        • Olsson A.
        • Nissen E.
        • Norman M.
        Is it necessary to suture all lacerations after a vaginal delivery?.
        Birth. 2000; 27: 79-85
        • Steen M.
        • Cooper K.J.
        • Marchant P.
        • Griffiths-Jones M.
        • Walker J.
        A randomised controlled trial to compare the effectiveness of icepacks and epifoam with colling maternity gel pads at alleviating postnatal perineal pain.
        Midwifery. 2000; 16: 48-55
        • Steen M.
        • Marchant P.
        Aleviating perineal trauma: the APT Study.
        RCM Midwives Journal. 2001; 4: 256-259
        • Seaton S.M.
        • Reeves M.
        Oxycodone as a component of multimodal analgesia post-caesarean section in Australia and New Zealand.
        Journal of Pharmacy Practice and Research. 2009; 39: 104-108
        • Grol R.
        • Grimshaw J.
        From best evidence to best practice: effective implementation of change in patients’ care.
        Lancet. 2003; 362: 1225-1230
        • Grol R.
        Successes and failures in the implementation of evidence-based guidelines for clinical practice.
        Medical Care. 2001; 39: 46-54
        • Schuster M.
        • McGlynn E.
        • Brook R.
        How good is the quality of health care in the United States?.
        Milbank Quarterly. 1998; 76: 517-563
        • Grol R.
        • Wensing M.
        What drives change? Barriers to and incentives for achieving evidence-based practice.
        Medical Journal of Australia. 2004; 180: S57-S60
        • Vazirani S.
        • Hays R.
        • Shapiro M.
        • Cowan M.
        Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses.
        American Journal of Critical Care. 2005; 14: 71-77
        • NHMRC
        Commonwealth of Australia National Guidance on Collaborative Maternity Care. NHMRC, Canberra2010
        • Searles J.A.
        • Pring D.W.
        Effective analgesia following perineal injury during childbirth: a placebo controlled trial of prophylactic rectal diclofenac.
        BJOG: An International Journal of Obstetrics and Gynaecology. 1998; 105: 627-631
        • Brunner L.
        • Suddarth D.
        Medical surgical nursing.
        8th ed. Lippincott-Raven publishers, Philadelphia1996
        • Peter E.
        • Janssen P.
        • Grange C.
        • Douglas J.
        Ibuprofen versus acetaminophen with codeine for the relief of perineal pain after childbirth: a randomized controlled trial.
        Canadian Medical Association Journal. 2001; 165
        • Parvaz M.
        • Moretti M.
        • Djokanovic N.
        • Bozzo P.
        • Nulman S.
        • Koren G.
        Guidelines for maternal codeine use during breastfeeding; motherisk update.
        Canadian Family Physician. 2009; 55
        • Kettle C.
        The management of perineal trauma.
        in: Henderson C. Bick D. Perineal care: an international issue. Quay Books, Wiltshire2005
        • Steen M.
        • Briggs M.
        • King D.
        Alleviating postnatal perineal trauma: too cool or not to cool?.
        British Journal of Midwifery. 2006; 14: 304-306
        • East C.
        • Begg L.
        • Henshall N.
        • Marchant P.
        • Wallace K.
        Local cooling for relieving pain from perineal trauma sustained during childbirth.
        Cochrane Database of Systematic Reviews. 2007; ([serial on the Internet])
        • Dodd J.M.
        • Hedayati H.
        • Pearce E.
        • Hotham N.
        • Crowther C.A.
        Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories.
        BJOG: An International Journal of Obstetrics and Gynaecology. 2004; 111: 1059-1064