Maintaining women's perineal integrity : participatory action research study

Childbirth-related perineal trauma can cause long and short term complications. Although best practice guidelines recommend against routine episiotomy, it is liberally used; particularly for primiparous women. We used a participatory action research (PAR) design for this study including 119 participants. The first PAR cycle aimed to gather baseline data and the second PAR cycle included implementing a set of staff training activities and evaluating their effectiveness. The three most important factors for promoting positive practice change were management involvement and support, evidence-based midwifery practice guidelines and focussed staff training.