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Prevention and Management of Severe Obstetric Anal Sphincter Injuries (OASIs): a National Survey of Nurse- Midwives

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Abstract

Introduction and hypothesis

There are no data on midwives’ knowledge and management of obstetric anal sphincter injuries (OASIs) in the USA. We performed a cross-sectional national survey characterizing OASI practice by certified nurse midwives (CNMs), hypothesizing that few midwives personally repair OASIs and that there are gaps in CNM OASI training/education.

Methods

We emailed a REDCap internet-based survey to 6909 American College of Nurse Midwives members (ACNM). We analyzed responses from active clinicians performing at least one delivery per month, asking about OASI risks, prevention, repair, and management. We summarized descriptive data then evaluated OASI knowledge by patient and provider characteristics.

Results

We received 1070 (15.5%) completed surveys, and 832 (77.8%) met the inclusion/exclusion criteria. Participants were similar to ACNM membership. Respondents most frequently identified prior OASI (87%) and nutrition (71%) as antepartum OASI risk factors and, less frequently, nulliparity (36%) and race (22%). Identified intrapartum risks included forceps delivery (94%) and midline episiotomy (88%). When obstetric laceration is suspected, 13.6% of respondents perform a rectal examination routinely. Only 15% of participants personally perform OASI repair. Overall, participants matched 64% of evidence-based answers. OASI education/training courses were attended by 30% of respondents, and 44% knew of OASI protocols within their group/institution. Of all factors evaluated, the percent of evidence-based responses was only different for respondent education/CME and protocols.

Conclusions

Quality initiatives regarding OASI prevention and management may improve care. Our data suggest OASI training for midwives may improve delivery care in the US. Further studies of other obstetric providers are needed.

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Acknowledgements

We acknowledge Andre Owens for his assistance implementing the invitations and Nicole Carlson, CNM, PhD, for her input on project design and the consensus process. We especially thank all the participants from ACNM without whom we could not have done this work.

Funding

This work was supported by the Rocky Vista University College of Osteopathic Medicine Intramural Research Grant (SD), the Department of Obstetrics and Gynecology (KJH), the Society of Family Planning Junior Investigator Career Grant SFPRF10-JI1 (MG), and the NIH/NCRR Colorado CTSI grant no. UL1 RR025780 (RedCap resource). Its contents are the authors’ sole responsibility and do not necessarily represent official UC Denver, Rocky Vista University, or NIH views.

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Authors and Affiliations

  1. Department of Surgery, St. Joseph’s University Medical Center, Paterson, NJ, USA

    Sindi Diko

  2. Divisions of Family Planning, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Maryam Guiahi

  3. Nurse Midwifery Program, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Amy Nacht

  4. Division of Urogynecology, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Kathleen A. Connell

  5. Division of Reproductive Sciences, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Kathleen A. Connell & K. Joseph Hurt

  6. Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Shane Reeves, Beth A. Bailey & K. Joseph Hurt

  7. University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Mailstop 8613, Aurora, CO, 80045, USA

    K. Joseph Hurt

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  1. Sindi Diko
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  2. Maryam Guiahi
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  3. Amy Nacht
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  4. Kathleen A. Connell
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Correspondence to K. Joseph Hurt.

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Conference Presentations

ACOG Annual Meeting. San Diego, CA, May 2017

Appendix

Appendix

Table 5 Consensus panel evidence-based practices for OASI prevention and management
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Table 6 Frequency of participants who matched consensus answer choices regarding ante- and intrapartum risk factors
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Table 7 Frequency of participants who matched consensus answer choices regarding procedures performed at time of OASI repair and management approaches for patients with 3rd- or 4th-degree lacerations
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Table 8 CME, protocols, and routine rectal examinations for those who personally repair OASIs
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Table 9 Approach to OASI repair after primary or subsequent lacerations
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Table 10 Participant response to performing episiotomies
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Table 11 Participant free-text responses listing their routine OASI prevention techniquesa
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Table 12 Knowledge and practice for OASIs by participant characteristics
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Diko, S., Guiahi, M., Nacht, A. et al. Prevention and Management of Severe Obstetric Anal Sphincter Injuries (OASIs): a National Survey of Nurse- Midwives. Int Urogynecol J 31, 591–604 (2020). https://doi.org/10.1007/s00192-019-03897-x

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