POSTNATAL CARE: CHECKING THE STITCHESDevelopment of a midwifery-led postnatal clinic with expertise gained from more than 150 early secondary perineal repairs. Experiences from Aarhus University Hospital in Denmark.

AuthorsSara Kindberg is midwife, Master of Health Sciences and PhD. The title of her PhD was: ”Perineal lacerations after childbirth. Studies within midwifery practice on suturing and pain relief” and was performed at the Faculty of Health Sciences, Aarhus University, Denmark in 2008. Sara currently works as a Perineal Care Specialist Midwife at Aarhus University Hospital in Denmark. She supervises midwives and obstetricians during postpartum perineal repair and conducts hands-on workshops within the fields of surgical skills, pain relief methods and diagnosing perineal injury. Sara is also head of an interprofessional, national Pelvic Floor Unit implementing early secondary perineal repair.

Misan Stehouwer is midwife and Master of Health Sciences. Her master thesis was a 3-year follow-up on postpartum perineal repair comparing pain and dyspareunia in second-degree tears and episiotomies. Misan currently works a Midwifery Manager at Aarhus University Hospital. She has been involved in the development of a guideline on early secondary perineal repair.

WorkflowAll women who have given birth vaginally are offered a postnatal examination of wound healing 48-78 hours after birth, as part of the routine postnatal maternal and baby health check.

Results After we began to screen all women with perineal injury, we found that approximately 2-4% were candidates for early secondary perineal repair. A guideline was developed in order to ensure uniformity in decision-making and patient treatment.

Key focus areas for clinical improvement in postpartum perineal repair were identified. Hands-on workshops in basic surgical skills and for diagnosing perineal trauma are now available for all staff members on a monthly basis. If required, individual supervision is possible for midwives or doctors during perineal repair procedures, 24 hours / 7 days a week.

BackgroundAarhus University Hospital has implemented a new midwifery-led postnatal service that includes an examination of perineal wound healing. A group of specially trained midwives conduct early secondary repair if it is found that wounds have been insufficiently repaired or if there has been an underdiagnosis of perineal trauma.

ConclusionDiagnosis and primary perineal repair is successfully performed on more than 95% of all patients after vaginal birth. In cases of insufficiently sutured wounds, it is possible to perform an early secondary repair within the first week post partum with good results.

A Visual Analogue Scale is used to evaluate pain. The REEDA tool is used to evaluate wound healing. Patient satisfaction is evaluated by visual inspection, either by using a mirror or taking a photo of the healing area.

References1. Kindberg S: Midwifery-led services in a postnatal clinic. Systematic evaluation of perineal wound healing in hospital (case study 4). European strategic directions for strengthening

nursing and midwifery towards Health 2020. Nurses and midwives, A vital resource for health compendium. WHO Regional Office for Europe 2015.2. Kindberg S, Stehouwer M, Hvidman L, Henriksen TB: Postpartum perineal repair performed by midwives: a randomised trial comparing two suture techniques leaving the skin unsu-

tured. BJOG. 2008 Mar;115(4):472-9. 3. Dudley LM, Kettle C, Ismail KM. Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth. Cochrane Database Syst Rev. 2013 Sep

25;9:CD008977.4. Christensen S, Anderson G, Detlefsen GU, Hansen PK. Treatment of episiotomy wound infections. Incision and drainage versus incision, curettage and sutures under antibiotic cover;

a randomised trial. Ugeskrift for Laeger 1994;156(34):4829-33.5. Monberg J, Hammen S. Ruptured episiotomia resutured primarily. Acta Obstetricia et Gynecologica Scandinavica 1987;66(2):163-4.

Checking the Stitches Sydney version m Henriette.indd 1 26/09/16 11:44