Towards an understanding of midwifery practice in relation to managing the risk of severe perineal trauma for women of Asian ethnicity in the Australian setting : an ethnography

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Introduction: Asian ethnicity is a significant risk factor for severe perineal trauma during vaginal birth. Some Australian hospitals care for a high proportion of women of Asian ethnicity, yet little is known about the practices of midwives in relation to managing this risk. Aim: To explore midwifery clinical practice used to minimise perineal trauma for Asian women anticipating a normal labour and spontaneous vaginal birth, within one hospital-based Delivery Suite in New South Wales (NSW), Australia. Methodology: The research design selected for the study was ethnography. Method: The ethnographic techniques used for the study included observations, interviews and focus groups. The total sample for the study consisted of 22 midwives, six midwifery students and 18 women of Asian ethnicity having their first baby. Ethnographic data included 13 interviews, four focus groups and 18 observations of midwives caring for women of Asian ethnicity during the second stage of labour and birth. An ethnographic framework was used for the analysis and interpretation of data. Findings: A Delivery Suite midwifery culture of care was identified in the following six key themes: The geography of care, midwifery cultural beliefs and Asian women, the midwife-woman relationship, a communication link, protecting the perineum: rituals and patterns of practice and the right to influence and control. Midwifery practice and the woman’s childbirth experiences are shaped by the physical environment, midwifery cultural beliefs and shared patterns of care, which set the potential for reducing or increasing the incidence of maternal perineal trauma. The midwife-woman trust and communication link is recognised as underpinning the effectiveness of all clinical practice strategies in reducing perineal trauma for Asian woman. A relationship of trust is known to reduce maternal fear and lower the incidence and severity of perineal trauma. Attempting to minimise perineal trauma for Asian women is associated with an ongoing clinical practice evolution embedded in the power and control dynamics within the midwifery cultural group in the Delivery Suite. Conclusion: The evidence for changing maternity systems towards a more democratic, collaborative, midwifery-led focus is compelling. A strong midwifery social identity can support transformation of practice, promote the quality and safety of care, improve childbirth outcomes and reduce the likelihood of severe perineal trauma for all women.
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