Perineal Suturing – A Vital Area of Care for Women

In collaboration with ID Medical School, Perineal Midwife Specialist Adelaide Aduboffour is hosting a 10 CPD point interactive workshop on perineal suturing on Sunday 29 March 2015. (For a limited time only, get £100 off the course fee!)

Perineal Suturing – Background

Around 85% of women who have a vaginal delivery will sustain perineal trauma, which occurs either spontaneously or as a result of episiotomy. In the United Kingdom, assessment and perineal suturing are procedures mainly undertaken by midwives, some of whom may not have received updated or adequate basic training (Bick et al 2010).

Identification, correct classification and the technique used to repair perineal injury are procedures that require knowledge and skills to ensure that the tissues involved are correctly aligned to facilitate healing and minimise postpartum morbidity.

The NHS Litigation Authority report (2012) shows a rise in negligence claims associated with poorly assessed and poorly repaired perineal trauma. The total value of those claims and legal cost to the NHS was estimated to be 31.2 million.

Adelaide Aduboffour: From midwife to Perineal Specialist Midwife and director of Peri Health Limited, working with ID Medical School to enhance the skillsets of midwives to achieve NHS practising standards

With over 10 years’ experience in midwifery, Adelaide Aduboffour recognised the need for high-quality perineal suturing training, not just for midwives, but for junior doctors and students too. With her vision and passion to teach through many years working on the delivery suite in her current role as a Perineal Specialist Midwife at a busy NHS maternity unit in London, Adelaide provides advice to her healthcare colleagues in this specialist area of care. Most recently, she helped to establish a thriving perineal clinic.

Working with midwives on the labour ward to help improve their competency in perineal assessment, Adelaide’s teaching methods have proven to develop their knowledge and skills in suturing, as well as lessen any associated fear with carrying out the procedure. With that, she has now taken on part-time work as a midwifery lecturer at a London-based University, where she facilitates a suturing workshop for our next generation of midwives, and – is a published author with her latest publication titled, ‘Sex and Romance during pregnancy after birth: What expectant couples need to know’.

Her relentless pursuit, drive and dedication to teach others to provide continuity of care for women didn’t end there. Peri Health Limited was founded with the aim of running CPD accredited specialist perineal suturing training which enables midwives to improve their perineal assessment and suturing skills based on current evidence, to minimise post-partum morbidity. Hosted in a friendly and relaxed environment, Adelaide’s training courses are interactive, practical and informative.

Adelaide outlines the aims of her workshop:

• 1.To provide confidence in repairing perineal traumas (1^st and 2^nd degree tears, episiotomy).
• 2.Enable midwives and healthcare staff to develop the knowledge and skills required to recognise, assess and repair perineal trauma independently according to the current guidelines.
• 3.To provide midwives and healthcare staff with knowledge and skills required for competently performing episiotomy.
• 4.To improve efficiency and time management on the labour wards as well as patient experiences. (If the midwife is competent to carry out suturing, there will be no need to wait for several hours for another colleague to carry out the procedure. This can be time consuming and frustrating for the woman and the staff, especially if the labour ward is busy).
• 5.To provide the midwives and healthcare staff with the opportunity to practice the skills under supervision during the training session.

By the end of the workshop, delegates should be able to:

• Understand the anatomy and physiology of the pelvic floor structures and their significance to trauma sustained during childbirth.

• Describe when the use of episiotomy may be required in midwifery practice.
• Describe how to infiltrate the perineum and incise an episiotomy.
• Discuss the role and responsibility of the midwife when completing perineal repair.
• Discuss current evidence for the choice of material and techniques when performing perineal repair.
• Describe the choice of anaesthetic and procedure for perineal infiltration.
• Develop an understanding of knot tying and various suturing techniques such as interrupted, continuous and subcuticular.
• Understand the documentation requirement of episiotomy and suturing.
• Discuss perineal and pelvic floor care women require following childbirth.

The workshop comprises two sessions; theory and practical.

Theory session:

• Interactive presentation and real-life case studies relevant to the subject
• Visual aids (images, anatomical models of the female pelvis and pelvic floor muscles)
• Audio visual aids (video of repair of episiotomy, assessment and diagnosis of third degree tear)
• Group discussions
• Quiz

Practical Session

Simulation offers an important context for clinical education. It provides a structured, safe and supportive environment to bridge the classroom and the clinical environment.

Delegates will use a simulation pad (mimics human tissue) to practice the following:

1.The handling of surgical instruments

2.Knot tying

3.Interrupted suturing

4.Continuous non-lock technique

Midwives are provided with a simulated perineum to practice suturing as many times as possible until they feel confident with the technique. The perineal simulator has an accurate life size anatomy with all the relevant landmarks, and the model gives highly realistic feedback during suturing. It has an open rectum for digital assessment and verification that the rectum has not been sutured.

Working in collaboration with the UK’s leading healthcare recruiter ID Medical to improve skills in the area of suturing and perineal care, Adelaide will be hosting her Perineal Suturing Workshop at ID Medical’s HQ in Milton Keynes on Sunday 29 March. Read more.