Abstract
Background
A care bundle to reduce severe perineal trauma (the bundle) was introduced in 28 Australian
maternity hospitals in 2018. The bundle includes five components of which only one
– warm perineal compresses – has highest level evidence. There is scant published
research about the impact of implementation of perineal bundles.
Question
How does a perineal care bundle impact midwifery practice in Australian maternity
hospitals?
Methods
Purposively sampled midwives who worked in hospitals where the bundle had been implemented.
Interested midwives were recruited to participate in one-to-one, semi-structured interviews.
The researchers conducted critical, reflexive thematic analysis informed by Foucauldian
concepts of power.
Findings
We interviewed 12 midwives from five hospitals in one state of Australia. Participants
varied by age, clinical role, experience, and education. Three themes were generated:
1) bundle design and implementation 2) changing midwifery practice: obedience, subversion,
and compliance; and 3) obstetric dominance and midwifery submission.
Discussion
The bundle exemplifies tensions between obstetric and midwifery constructs of safety
in normal birth. Participants’ responses appear consistent with oppressed group behaviour
previously reported in nurses and midwives. Women expect midwives to facilitate maternal
autonomy yet decision-making in maternity care is commonly geared towards obtaining
consent. In our study midwives encouraged women to consent or decline depending on
their personal preferences.
Conclusion
The introduction of the perineal bundle acts as an exemplar of obstetric dominance
in Australian maternity care. We recommend midwives advocate autonomy – women’s and
their own – by using clinical judgement, evidence, and woman-centred care.
Keywords
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Article info
Publication history
Published online: January 20, 2021
Accepted:
January 13,
2021
Received in revised form:
January 13,
2021
Received:
September 23,
2020
Identification
Copyright
© 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
