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The Perineum

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Thoughts & musings on midwifery related topics for the February Education Newsletter. 

Ruth King, Midwifery Advisor, Education Unit


The Perineum is such a sensitive area for women, both physically and also to talk about.  It is not really a standard topic of conversation, unless you happen to be with a group of midwives doing a perineal repair workshop, or with some very open minded women who feel comfortable talking about what did or did not happen to them (and their perineum) during pregnancy and birth.

So much value has been placed on understanding the implications of trauma to the perineum (for women but also for care pathways) that there have been studies galore on care and prevention practices for pregnancy, labour, birth and the postnatal period.  A quick search on Australian College of Midwives  Women and Birth International Journal^ recovered 109 articles where the perineum has been mentioned and 18 where ‘perineum’ is specifically listed as a keyword, in the title or abstract and the journal Midwifery has 194 and 77 articles respectively. That is a lot of evidence to READ and digest (and REFLECT upon)!

The ACM values this area of knowledge for all midwives and supports learning through our webinar series, articles in the Australian Midwifery News magazine and Women and Birth journal as well as many of the Branches running practical workshops for upskilling midwives, such as those wanting to refresh or the ones looking to delve into the world of suturing. 

In 2016 we asked Rachel Smith, a midwife in NSW and skilled educator, to share her knowledge around perineal care, with the midwifery community, via a webinar.  Rachel has a beautiful presenting style and she covers the topics in an informative and engaging way (with some fabulous graphics to help you visualize the intricate bits!).  Her webinar covers all of the basics such as anatomy, how to care for the perineum in pregnancy and potentially prepare it for birth as well as covering evidence based assessment and repair and postnatal care and healing.

You can ACCESS the webinar directly in Midwives Learn from here as long as you have the Self-enrolment access key (Members only benefit).  The access key can be found on the member benefits pages.  Remember, you no longer need to go via the shop and purchase the recording (as you used to need to), but if you do go that way, you must remember to log in to your member portal or you will only see the non member pricing. 

In 2014 we joined with the Continence Foundation of Australia to develop an online learning program that addresses all things perineum (and all the bits related to continence affected by the perineum!).  Since the release we have had over 4000 individuals enrol! You can purchase access to the course ‘Continence: the importance of the midwife” from our shop.  Your options are to purchase the entire course (6 modules, 8 hours) for a specially discounted rate of $88.00 for ACM members (that’s a whopping 50% off non member prices). Or, you can pick and choose the module you want to access and pay $20 per module (Non members pay $40).

Some stats from the individuals who have completed the course. 

Greater than 80% of individuals completed this course whilst at home, with the remainder at work. More than 90% liked the way the course was structured and thought it was easy to navigate, was easier to undertake and more convenient than a face to face event, was relevant to their practice and enhanced their knowledge.  Specifically people liked the images and the resources and the level of details provided.

Thinking about suturing…

Have you ever thought of using a banana to learn to suture? I was watching an ABC doco and they talked about this as a technique, for doctors, and it got me thinking… Would it be a suitable starting space for the novice?  One of the most common practice materials currently used are foam blocks (with or without shaping and colour to help them resemble a torn vagina). I remember when I started out as a student the teachers talked about the days when they used pigs trotters as the skin and muscle layers were similar. I am not 100% convinced about using a banana for midwives to learn with as I am not sure that the banana skin can really be thought of as similar to the intricate layers of the vaginal tissue but if you have never ventured into this area it might be a good place to start.  Or check out what your branches have on offer as far as workshops^^…

Next steps

Whatever pathway you chose to learn more about the perineum, for yourself, or your conversations with women, we encourage you to start off by REFLECTING^^^ on what you know and what you think your LEARNING OUTCOMES might be (eg what need to address) so that you can come back after your CPD journey and determine whether you met those needs or need to do more.

^ACM Members remember you get free access to ALL Women & Birth International Journal articles as part of your membership.  There are 6 issues per year.

^^ SA Perineal Suturing workshops available in May & October.

^^^ You can access more information about reflective activities and templates on our website

*Non members you will need to purchase the webinar recording via our shop.  Members you can find details about how to access the webinar recordings via the Member Benefits pages on the website