A Women-Centred Exploration of the Determinants of Postpartum Perineal Pain when the Perineum is Diagnosed as Intact: A Gadamerian Hermeneutic Study

  • Caroline (Le Roux) Matteo

Student thesis: Doctoral ThesisProfessional Doctorate (ProfD)

Abstract

Background
Perineal pain is an issue that affects the majority of women following birth (Andrews et al 2008), sometimes leading to consequences on multiple levels such as the ability to carryout daily tasks, breastfeeding, mental health, and sexual activity. Background literature shows that pain levels and the experience of pain are not only defined by the presence or absence of an injury. This prompted focusing on specific cases where the perineum was diagnosed as intact to understand the possible factors influencing the postpartum pain experience. A literature review highlighted the gap in published evidence regarding a women-centred perspective of the experience of postpartum perineal pain in the absence of visible injury and its possible determinants. The study aimed to gain an understanding of women’s experiences of postpartum perineal pain when the perineum is diagnosed as intact.

Methodology and methods
A Gadamerian hermeneutic research methodology was chosen to achieve the research aim. Women having given birth vaginally to a single live child, who were identified as having an intact perineum, were approached during their maternity stay in September and October 2019, and invited to participate in two interviews. An analysis of the data using Fleming et al’s (2003) five steps method was carried out. Ethical approval had been granted before accessing participants by the Avignon Ethical Committee and the Glasgow Caledonian University ethics committee.

Findings and discussion
Eleven women were interviewed face-to-face between five to ten weeks postpartum, six of whom agreed to be reinterviewed over the telephone between six to eight months postpartum. The analysis identified three main themes that add to knowledge on the determinants of perineal pain in postpartum: “Can’t honestly call it pain”, “Reassurance in normality”, and “Managing the unexpected”. These findings highlight the specific nature of perineal sensations in postpartum that prevent them from being dealt with and cared for in the same way as other types of pain. The determinants of postpartum perineal painful sensations identified are closely related to inner resources and strengths that help women positively react to these sensations. Ability to give meaning, opportunity to confirm normality, and capacity to manage the unexpected are the main elements that help women go through the experience of postpartum pain.

Conclusion
This study suggests that caregivers should refrain from using the words pain and intact to assess the perineal experience in the perinatal setting, as this is not in accordance with women’s experiences. The discussions about pain during consultations by health professionals should be questioned and modified. Perineal looseness is a sensation that should be inquired about, the participants described this as disturbing. The study suggests that women use inner resources, preparedness, and self-confidence to deal with the perineal sensations that they experience postpartum. Health professionals should foster these tools and abilities to improve the experience of postpartum perineal pain.
Date of Award2022
Original languageEnglish
Awarding Institution
  • Glasgow Caledonian University
SupervisorGordon Hill (Supervisor), Nicola Roberts (Supervisor) & Hazel Hill (Supervisor)

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