Developing and sustaining skills, competencies and confidence of newly registered midwives to manage, assess and repair maternal perineal trauma: A mixed methods study

Research question How can we develop and sustain skills, competencies and confidence of newly registered midwives to manage, assess and repair perineal trauma?

Background During 2021-2022, around 450,000 UK women who gave birth sustained perineal trauma, around 60% sustaining a second-degree tear and 5% a more severe 3rd or 4th degree tear1. Women who sustain injuries can face life-long health impacts.

Most women who have spontaneous vaginal birth in the UK are attended by midwives who should be skilled and competent in this aspect of care, informed by Nursing and Midwifery Council (NMC) Standards of Proficiency for registered midwives2.

However, many women receive sub-optimal care which impacts detrimentally on their health and contributes to inequalities in care as many midwives are not appropriately skilled in perineal management.

We urgently need to know how best to support midwives to develop and maintain clinical skills, underpinned by knowledge of pelvic floor anatomy and physiology and hands-on training in evidence-based assessment and repair of perineal trauma.

Aims and Objectives We aim to support newly-registered midwives develop, consolidate and implement skills to assess and manage women s perinea immediately following birth.

Objectives include: To better understand how midwives learn and maintain competencies in perineal care and develop confidence in clinical skills To identify and prioritize what matters to women and newly-registered midwives in terms of education and training in pelvic floor health/perineal care To develop a comprehensive e-learning training pathway and implementation strategy To feasibility/pilot test the training pathway in labour ward settings To develop economic models to highlight potential NHS costs/savings in use of a training pathway Methods Mixed methods research with five work packages: WP1 (1-5m): Rapid systematic review of published evidence to identify interventions to enhance and sustain clinical skills and competencies in wound assessment and management, resource use costs and economic outcomes.

WP2 (2-5m): Interviews with ≤15 women who had perineal tears or episiotomy in previous 6 months at three NHS sites to explore priorities for midwifery training to promote optimal perineal care.

Interviews with newly-registered midwives, preceptors, university lecturers, student midwives, consultant midwives (n=12) will explore perceptions, expectations and experiences of teaching on aspects of perineal care.

WP3 (6-9m): Informed by WPs 1,2, develop an e-learning pathway in perineal care, informed by Experience-Based Co-Design workshops with women and midwives. WP4 (10-21m): Assess feasibility of the intervention in practice. Interview ≤10 newly-registered midwives and preceptors at three NHS sites for views of this.

Following refinements, pilot the intervention over six months in our three study sites and interview ≤15 midwives and ≤10 women. WP5 (22-24m): Develop economic models to highlight potential NHS costs/savings.

Impact and Dissemination A co-designed, piloted e-learning resource to improve skills and competencies of newly-registered midwives to manage perineal trauma available to all UK midwives. Potential to improve women s experiences of care and reduce morbidity.

Findings will be shared with the NMC, RCM and disseminated via peer review journals, policy, professional and service user events using targeted tailored direct contact and social media.