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Perineal resuturing versus expectant management following vaginal delivery complicated by a dehisced wound (PREVIEW): a nested qualitative study
  1. L Dudley1,2,
  2. C Kettle2,
  3. J Waterfield3,
  4. Khaled M K Ismail4
  1. 1The Maternity Centre, Royal Stoke, University Hospitals of North Midlands, Staffordshire, UK
  2. 2Faculty of Health Sciences, Staffordshire University, Stafford, UK
  3. 3School of Health and Rehabilitation and Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK
  4. 4Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  1. Correspondence to Professor Khaled MK Ismail; k.ismail{at}bham.ac.uk

Abstract

Objective To explore women's lived experiences of a dehisced perineal wound following childbirth and how they felt participating in a pilot and feasibility randomised controlled trial (RCT).

Design A nested qualitative study using semistructured interviews, underpinned by descriptive phenomenology.

Participants and setting A purposive sample of six women at 6–9 months postnatal who participated in the RCT were interviewed in their own homes.

Results Following Giorgi's analytical framework the verbatim transcripts were analysed for key themes. Women's lived experiences revealed 4 emerging themes: (1) Physical impact, with sub-themes focusing upon avoiding infection, perineal pain and the impact of the wound dehiscence upon daily activities; (2) Psychosocial impact, with sub-themes of denial, sense of failure or self-blame, fear, isolation and altered body image; (3) Sexual impact; and (4) Satisfaction with wound healing. A fifth theme ‘participating in the RCT’ was ‘a priori’ with sub-themes centred upon understanding the randomisation process, completing the trial questionnaires, attending for hospital appointments and acceptability of the treatment options.

Conclusions To the best of our knowledge, this is the first qualitative study to grant women the opportunity to voice their personal experiences of a dehisced perineal wound and their views on the management offered. The powerful testimonies presented disclose the extent of morbidity experienced while also revealing a strong preference for a treatment option.

Trial registration number ISRCTN05754020; results.

  • Postnatal
  • Perineum
  • Dehiscence
  • Womens experience

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors LD, CK and KMKI conceived the idea for the study. All authors contributed to the design of the study. LD performed the qualitative analysis for the study supported by JW. LD was the PREVIEW study coordinator; she completed the research as part of her doctoral studies at Staffordshire University. All authors contributed equally to this work.

  • Funding PREVIEW was funded by the National Institute for Health Research, Research for Patient Benefit (RfPB) (PB-PG-090920079) and sponsored by the Royal Stoke University Hospital. The midwife researcher conducting the interviews (LD) also received a Doctoral Nursing Studentship award from the Smith and Nephew Foundation/Research into Ageing (RIA) Age Concern (2008–2011).

  • Competing interests CK and KMKI run perineal repair workshops both nationally and internationally and have developed an episiotomy and second-degree tear training model with Limbs and Things, UK. They receive a small royalty fee that contributes towards women's health research funds.

  • Patient consent Obtained.

  • Ethics approval PREVIEW was approved by the North Wales Research Ethics Committee (Central and East) reference number: 10/WNo03/16.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Professor CK and Professor KMKI run perineal repair workshops both nationally and internationally and have developed an episiotomy and second-degree tear training model with Limbs and Things, UK and an online training package ‘MaternityPEARLS’. They receive small royalty fees from these developments that contribute towards women's health research funds.

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