What is the issue?

In hospitals, a large majority of women who give birth vaginally suffer from an injury to their perineum, the area of skin and muscle between the anus and the vagina. This injury may be bruising or tearing, or occur as a result of a deliberate cut to assist with childbirth. As women are often discharged from hospital very shortly after childbirth, they may be left to care for this wound themselves, without healthcare supervision. The type and extent of the injury varies, as does the treatment for these wounds. They might have stitches, need cold packs and analgesics or anti-inflammatories for pain relief; or salt baths, wound packing, and antibiotics to help with healing. Many women are not warned of the likelihood or prepared for a perineal wound. They do not know how to manage and care for the wound. This may result in complications such as increased pain and discomfort, distress, risk of infection, and difficulty with urination and having sexual intercourse. This review aimed to examine whether providing education to women before childbirth, about the expectation and management of a perineal wound, made a difference to wound healing after childbirth.

Why is this important?

Perineal wounds that do not heal well impact poorly on women’s health, on the relationship between the mother and her baby, and on family relationships. Healthcare professionals are in the unique position of being able to provide up-to-date and accurate advice, and can play a key role in educating women in this important aspect of their personal care. Appropriate formal education provided before childbirth might lessen the shock and distress associated with a perineal wound, and empower the mother to manage the treatment of the wound, thereby reducing the risk of complications. This review aimed to examine whether providing education to women before childbirth, either as part of antenatal education or during visits to their healthcare provider, made a difference to wound healing after childbirth.

What evidence did we find?

We searched for evidence in September 2017 but did not find any randomised controlled studies relating to our area of interest. We excluded one study and one other study is not yet complete.

What does this mean?

We cannot say whether or not antenatal education has an effect on perineal wound healing after childbirth among women who have birthed in a hospital setting. We do not know from randomised controlled trials what the benefits and harms of this education might be. More research is this area is needed to determine the impact of education delivered before childbirth on perineal wound healing in women who have birthed in a hospital setting. Trials may also examine the outcome on related issues including infection rate, re-attendance or re-admission to hospital, pain, health-related quality of life, maternal bonding, and negative emotional experiences relating to a perineal wound. A large proportion of childbearing women experience a perineal wound in childbirth, and these wounds are known to have a significant physical, psychological and economic impact. Future research could examine the potential benefits of a tailor-made education package to be delivered to this cohort of women, as there is currently no evidence to support this.