1. Nurse-midwives' ability to diagnose acute third- and fourth-degree obstetric lacerations in western Kenya.
- Author
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Pinder, Leeya F., Natsuhara, Kelsey H., Burke, Thomas F., Lozo, Svjetlana, Oguttu, Monica, Miller, Leah, Nelson, Brett D., and Eckardt, Melody J.
- Subjects
VAGINAL fistula ,MIDWIVES ,PERINEAL care ,OBSTETRICAL emergencies ,MATERNITY nursing ,ANUS ,TRAUMATOLOGY diagnosis ,PERINEUM ,LABOR complications (Obstetrics) ,CLINICAL competence ,PATIENT aftercare ,MEDICAL referrals ,NURSING specialties ,PHYSICAL diagnosis ,TRAUMA severity indices ,PREVENTION ,DIAGNOSIS ,WOUNDS & injuries - Abstract
Background: Obstetric fistula devastates the lives of women and is found most commonly among the poor in resource-limited settings. Unrepaired third- and fourth-degree perineal lacerations have been shown to be the source of approximately one-third of the fistula burden in fistula camps in Kenya. In this study, we assessed potential barriers to accurate identification by Kenyan nurse-midwives of these complex perineal lacerations in postpartum women.Methods: Nurse-midwife trainers from each of the seven sub-counties of Siaya County, Kenya were assessed in their ability to accurately identify obstetric lacerations and anatomical structures of the perineum, using a pictorial assessment tool. Referral pathways, follow-up mechanisms, and barriers to assessing obstetric lacerations were evaluated.Results: Twenty-two nurse-midwife trainers were assessed. Four of the 22 (18.2%) reported ever receiving formal training on evaluating third- and fourth-degree obstetric lacerations, and 20 of 22 (91%) reported health-system challenges to adequately completing their examination of the perineum at delivery. Twenty-one percent of third- and fourth-degree obstetric lacerations in the pictorial assessment were incorrectly identified as first- or second-degree lacerations.Conclusion: County nurse-midwife trainers in Siaya, Kenya, experience inadequate training, equipment, staffing, time, and knowledge as barriers to adequate diagnosis and repair of third- and fourth-degree perineal tears. [ABSTRACT FROM AUTHOR]- Published
- 2017
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