The prevalence of enduring postnatal perineal morbidity and its relationship to type of birth and birth risk factors

Aims and objectives. To investigate the prevalence of perineal morbidity at 12 months postnatal and its relationship to type of birth and birth risk factors. Background. It is well documented that women endure short-term postnatal perineal morbidity following childbirth (e.g. incontinence, perineal pain and sexual morbidity). However, to date, very little research has been carried out on the long-term effects of perineal morbidity and its relationship to the type of birth the women experienced and other birth risk factors (e.g. ethnic origin, age, parity, length of labour, epidural anaesthesia). Design. A retrospective, cross-sectional community survey of postnatal women within two maternity units in Birmingham. Methods. A total population sample of 2,100 women were surveyed using a self-administered postal questionnaire. The questionnaire included self-assessment of perineal pain, perineal healing, urinary incontinence, flatus incontinence, faecal incontinence, sexual morbidity and dyspareunia. Demographic details, type of birth and birth risk factors were taken from the hospital's computerized maternity information system. Results. Four hundred and eighty-two women responded to the questionnaire (23.3%). Overall, a high level of enduring perineal morbidity was reported with 87% complaining of at least one index of morbidity. Instrumental births were associated with higher levels of certain types of perineal morbidity than women following a caesarean section or normal vaginal birth (stress and urge urinary incontinence, flatus incontinence, sexual morbidity and dyspareunia). In particular, women following a forceps birth reported higher levels of morbidity than normal or ventouse birth (continual, stress and urge urinary incontinence and flatus incontinence), even when comparing with the same degree of perineal trauma. Increasing age, increasing birth weight, length of labour and particularly Asian ethnic origin were also identified as risk factors for certain types of perineal morbidity. Conclusions. The study concludes that enduring perineal morbidity in women following childbirth is common, especially with women following a forceps birth and certain birth risk factors (i.e. age, ethnic origin, length of labour and birth weight). Relevance to clinical practice. These findings highlight the need for further research and provide a number of challenges for health-care services and health-care professionals.