Experiences of Adolescent Girls and their Midwives on Intrapartum Perineal Trauma in Selected Hospitals in Kumasi Metropolis

Introduction: Adolescent pregnancy and childbearing remain an important global public health concern. Several studies across the globe have enlisted numerous obstetric complications compromising adolescent pregnancy including perineal trauma. Such complications can occur during childbirth leading to increased risk of morbidity and mortality jeopardizing the survival of women and their babies. Significantly young maternal age and first time delivery is seen as the most common cause of Intrapartum Perineal Trauma (IPT). The midwife’s responsibility during delivery to prevent perineal trauma is often controversial. However, it is the responsibility of the midwife in guaranteeing that the active phase of the second stage is dawdling to assist prevents the perineum from injury.

Objective: the general objective is to explore the experiences of adolescent mothers and their midwives on birth-related perineal trauma in three selected Hospitals in Kumasi.

Methodology: this work adopted a descriptive case study approach using both quantitative and qualitative methods (mixed methods). This study again adopted a purposive sampling method which is a technique under the non-probability sampling, followed by simple random sampling. The study sample population was made-up of adolescent with vaginal deliveries for not more than 6 months who has experienced any form of intrapartum perineal trauma and midwives working at labour ward. This made it possible to select 6 adolescent girls and 72 midwives. Complete delivery information recorded in the delivery registers at the labour ward from 2017- 2019 were also sampled. The data collected using Electronic Data Collection Tool was aggregated into a Microsoft Excel file, cleaned and analyzed with SPSS (version 20). The descriptive statistics were compiled using frequency distribution tables and figures. Associations between variables were tested with correlation and regression analysis under the software Statistical package for Social Scientist. Thematic data analysis was employed for the qualitative aspect (open-ended question) and content analysis. The face-to-face interview with the adolescent was recoded, transcribed and analyzed using content analyses.

Results and Findings: The prevalence rate of adolescent in the calculation of total deliveries is low (16%) but the rate turns to be high (84%) when it’s taken in the context of all deliveries with IPT as complications of the second stage of labour. It was also found that 93% midwives were optimistic that, it is important as a practice to repair a perineal tear sustained by the adolescent. It was again found that midwives do not have adequate knowledge on non-pharmacological methods for perineal pain management unlike the high level of knowledge and practice on analgesia. It was also commonly found, that adolescents lack basic information about intrapartum perineal trauma during pregnancy. However, the prominent factor that posed greater likelihood of sustaining IPT was lack of knowledge on perineal trauma. The factors that posed greater likelihood of sustaining IPT were as follows: lack of knowledge on perineal trauma on the side of adolescent, lack of information on delivery positions; uncooperative adolescents; inadequate midwifery skills on perineal care and lack of value for IPT among adolescents. Poor knowledge in adolescent needs and reproductive health services were also significantly considered as risk factors.

Conclusion: There is the need for a Standard Operating Protocol for the improvement of knowledge and practice regarding prevention and management of perineal tear. Hospitals should prioritize intrapartum perineal trauma and add it to their reports. Adolescent’s reproductive health services should be re-established; proactive audit and supervision on IPT established in the hospitals.