Qualitative Study
A qualitative study by Priddis, Schmied and Dahlen (2014) seeks to identify the psychological impact of severe perineal trauma (SPT) on women and determine the impact of care on the patient’s experiences and subsequent recovery following birth. The purpose was clearly stated by the researchers and the qualitative approach necessary to collect such information is justified. The study is very small and focused, using face-to-face structured interviews with women in a local clinic that were recruited through word-of-mouth resulting in a group with shared experiences. This methodology is appropriate for the aims of the study in providing guidance that allows deriving highly descriptive summaries with concrete practical details (McIntosh & Morse, 2015).
The data collection process through the interviews is clear as the list of questions is presented, and the researchers describe the process of the interview, as well as clear ethical considerations, are taken such as approval by an ethics committee and creating pseudonyms for the participants. The interviews were recorded digitally and then transcribed. The researcher notes limitations regarding awareness of their place in the research using reflexivity to remain objective.
Data analysis was thorough as researchers identified three primary categories of experiences that may overlap including vulnerability during labor and birth, the disconnect between expectations and reality, and the emotional process that women undergo to rediscover themselves in relationships with the baby and sexual partners. The findings are supported by direct quotes from the participants which are then discussed by the researchers.
Some supporting data is presented in the discussion and there is a brief description of how the researchers formulated their thematic analysis and categories. The study highly succeeds in the process of developing themes by identifying the main features of a category and both its meaning and analytical importance, which are critical in this type of qualitative research (Vaismoradi, Jones, Turunen, & Snelgrove, 2016).
The extent of experiences does not allow for a concrete finding, but the researchers clearly state the impact of care on psychological experiences for women with SPT. This leads to a practical discussion and application, suggesting that further research and an examination of health management services are necessary during and post-natal periods for SPT. This is vital for midwifery and healthcare since incorporating patient experiences and outcomes into the care process is vital for patient engagement and enhancement of care (Lavallee et al., 2016). Particularly with SPT, women are vulnerable and undergo psychological trauma, resulting in the need for interventions for prevention and post-natal care.
Randomized Control Study
A randomized control trial study by Ugwu, Iferikigwe, Obi, Eleje, and Ozumba (2018) evaluates the effectiveness of an antenatal perineal massage (APM) intervention among pregnant women to reduce perineal trauma and other post-partum complications. It uses an RCT methodology with one control and one experimental group which were determined by a computer random sequence generator to eliminate bias. Medical personnel and obstetrics care providers at birth were blind to the treatment.
The trial was completed fully, and patients were analyzed in appropriate groups. Researchers account for any eligible participants which withdrew or did not give birth in the study location. It may have been beneficial to implement a cohort multiple randomized controlled trial design as means of using large long-term observations to compare the effectiveness of interventions on a specific population or condition (Relton, Thomas, Nicholl, & Uher, 2015).
The groups were close in size after withdrawals with only a difference of 2, and similar age of 28±3, all females. Other social characteristics were not collected but eligibility required a 34-36 gestational age, vaginal delivery, and a lack of diseases that could influence birth. There is no evidence that the groups were treated differently outside the interventions. The primary measured outcome was the presence and percentage of post-mortem morbidities. The APM intervention is studied to determine improvements in perineal outcomes in birth. The APM group was most likely to have an intact perineum and lower incidence of episiotomy as well as flatus incontinence.
The outcomes were measured through percentages of the total group and study participation. The study notes the small frequencies and wide confidence intervals as a limitation requiring a larger sample size, but no estimates were made to compare.
The study can be beneficial in recommending a simple procedure for pregnant women that can be performed at home with potential benefits for perennial outcomes. The patients may differ in a culture which leads to consideration of cultural competence is vital to implementation as at-home administered APM may not be easily implemented in developed countries as it has been in the study due to disparities in healthcare quality (Andrews & Diego-Mantecón, 2014) The clinical outcomes are recognized but it would have beneficial to see specific statistics of perennial trauma among the results. A cost-benefit analysis is necessary for modern health systems due to the high costs of care and the need to deliver healthcare efficiently (Sanders et al., 2016). APM is a low-cost intervention that can be taught and recommended to patients at regular appointments without any risks of harm and statistically significant improvements in perennial outcomes.
Systematic Review
A meta-ethnographic synthesis by Priddis, Dahlen, & Schmied (2013) examines studies on how women experience third- and fourth-degree perineal tears (SPT) during childbirth and subsequent outcomes. The review clearly focused on a specific population of women with that level of SPT, but the research question itself was unclear. The authors used a wide variety of medical databases for papers in a 15-year range from publication, but only four were selected. The synthesis focused on qualitative descriptive studies which are used to examine health care phenomena using a qualitative approach and limited samples through variability and flexibility of methods (Kim, Sefcik, & Bradway, 2016).
These are the appropriate types of papers to examine based on the review focus of non-quantitative data such as experiences. Relevant medical databases were searched, but the synthesis identified only four papers that the researchers found to meet the review aim. This sample seems small, and no discussion was made regarding following up with reference lists, experts, or other types of studies.
The authors used the CASP tool for quality assessment and met appropriate scholarly criteria along with being reviewed by at least two researchers to assess relevance. Quality determination is critical for systematic reviews to ensure a high validity of results, and the researchers can use a wide variety of methodological assessment tools include CASP, QUADAS, AMSTAR, and others for medical studies (Zeng et al., 2015). Results from individual studies were codified and displayed in a table, and later discussed in combination based on thematic elements identified. The review presented overall conclusions based on discovered evidence and synthesis.
The researchers clearly identified their findings and identified themes. Women with severe perennial trauma can experience complex and prolonged physical and psychological outcomes. Since all studies are qualitative, there are no measures of precision.
The review covers Western patients and health systems and can be applied to local populations and treatments. The clinical setting provides opportunities for application results. The analysis is very general, and potentially more data is necessary to understand the topic such as a greater emphasis on physical outcomes of the trauma. Although no specific intervention is presented, it suggested that greater health support is given throughout and after the labor and trauma. It can be noted that there is the possibility of health disparities for women and racial minorities, particularly in maternity care (Assari, 2018). Therefore, change may be costly on a systemwide basis, but can greatly improve health outcomes for women, both with and without trauma, justifying the benefits.
References
Andrews, P., & Diego-Mantecón, J. (2014). Instrument adaptation in cross-cultural studies of students’ mathematics-related beliefs: learning from healthcare research. Compare: A Journal of Comparative and International Education, 45(4), 545-567. Web.
Assari, S. (2018). Health disparities due to diminished return among black Americans: Public policy solutions. Social Issues and Policy Review, 12(1), 112–145. Web.
Kim, H., Sefcik, J. S., & Bradway, C. (2016). Characteristics of qualitative descriptive studies: A systematic review. Research in Nursing & Health, 40(1), 23-42. Web.
Lavallee, D. C., Chenok, K. E., Love, R. M., Petersen, C., Holve, E., Segal, C. D., & Franklin, P. D. (2016). Incorporating patient-reported outcomes into health care to engage patients and enhance care. Health Affairs, 35(4), 575-582. Web.
McIntosh, M. J., & Morse, J. M. (2015). Situating and constructing diversity in semi-structured interviews. Global Qualitative Nursing Research, 2, 1-12. Web.
Priddis, H., Dahlen, H., & Schmied, V. (2012). Women’s experiences following severe perineal trauma: A meta-ethnographic synthesis. Journal of Advanced Nursing, 69(4), 748-759. Web.
Priddis, H., Schmied, V., & Dahlen, H. (2014). Women’s experiences following severe perineal trauma: A qualitative study. BMC Women’s Health, 14(32), 1-11. Web.
Relton, C., Thomas, K., Nocholl, J., & Uher, R. (2015). Review of an innovative approach to practical trials: the ‘cohort multiple RCT’ design. Trials, 16(suppl2), 114. Web.
Sanders, G. D., Neumann, P. J., Basu, A., Brock, D. W., Feeny, D., Krahn, M., … Ganiats, T. G. (2016). Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses. JAMA, 316(10), 1093-1103. Web.
Ugwu, E. O., Iferikigwe, E. S., Obi, S. N., Eleje, G. U., & Ozumba, B. C. (2018). Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 44(7), 1252-1258. Web.
Vaismoradi, M., Jones, J., Turunen, H., & Snelgrove, S. (2016). Theme development in qualitative content analysis and thematic analysis. Journal of Nursing Education and Practice, 6(5), 100-110. Web.
Zeng, X., Zhang, Y., Kwong, J. S. W., Zhang, C., Li, S., Sun, F., … Du, L. (2015). The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. Journal of Evidence-Based Medicine, 8(1), 2-10. Web.