Research Article| Volume 36, ISSUE 1, e118-e124, February 2023

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A complex and demanding situation – Midwifery preceptors and midwifery students’ experiences of teaching and learning prevention of severe perineal trauma

  • Author Footnotes
    1 ORCID: 0000-0002-9718-754x
    H. Ulfsdottir
    Corresponding author.
    1 ORCID: 0000-0002-9718-754x
    Department of Women’s Health and Health professions Karolinska University Hospital, Stockholm, Sweden
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  • Author Footnotes
    2 ORCID: 0000-0002-0147-7084
    K. Johnson
    2 ORCID: 0000-0002-0147-7084
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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  • Author Footnotes
    3 ORCID: 0000-0001-7416-6335
    C. Rubertsson
    3 ORCID: 0000-0001-7416-6335
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
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  • Author Footnotes
    4 ORCID: 0000-0003-3139-6880
    M. Ekelin
    4 ORCID: 0000-0003-3139-6880
    Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
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  • Author Footnotes
    5 ORCID: 0000-0002-0968-6534
    M. Edqvist
    5 ORCID: 0000-0002-0968-6534
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
    Search for articles by this author
  • Author Footnotes
    1 ORCID: 0000-0002-9718-754x
    2 ORCID: 0000-0002-0147-7084
    3 ORCID: 0000-0001-7416-6335
    4 ORCID: 0000-0003-3139-6880
    5 ORCID: 0000-0002-0968-6534



      Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described.


      To describe midwifery preceptors and midwifery students’ experiences’ of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma.


      A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis.


      “A complex and demanding situation with mutual need for feedback, reflection and safety” was the overall theme describing the conditions. Three sub-themes were identified. “Adapting to a unique situation” refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. “Hindering and limiting circumstances” describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. “A trustful and communicative relationship” describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part.


      An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors’ confidence in teaching.


      SPT (Severe perineal trauma, i.e., perineal injuries affecting the anal sphincter muscle complex), FGD (Focus group discussions)


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