PhD project The project describes and compares experiences of health, quality of life and work ability at least 18 months after sustaining a third or fourth degree perineal laceration (severe perineal trauma [SPT]) at childbirth.
Swedish media and society have lately highlighted maternal morbidity related to SPT. In Sweden, the Perineal Laceration Register collects data on perineal lacerations up to one year postpartum, but several knowledge gaps exist on how and if women´s health, quality of life and work ability are affected by SPT in a longer period than the first year postpartum. This project aimes to describe and compare experiences of health, quality of life and work ability at least 18 months after sustaining SPT at childbirth by collecting data via a web-based questionnaire and interviews.
SPT is diagnosed and sutured in conjunction to childbirth, but research has shown that many women suffer from persisting maternal morbidity due to SPT. Knowledge gaps exist regarding maternal morbidity after SPT in a Swedish context, but international and some smaller national studies indicate that SPT can lead to pain, urinary and faecal incontinence, prolapse or sexual problems. Research has shown conflicting results regarding possible impact of maternal morbidity on quality of life, and despite extensive literature search, no studies on effects on work ability after SPT could be found.
Approximately 30 percent of women with SPT report persisting maternal morbidity one year postpartum in data from the Swedish Perineal Laceration Register. This research project may contribute with novel findings and close existing knowledge gaps regarding maternal morbidity after SPT in a Swedish context. Moreover, this project aims to improve care for affected women. An additional aim is to illuminate potential consequences for working life as well as possible impact on the sick cash benefit system by identifying potential risk factors regarding maternal morbidity and risk factors for diminished work ability.
This project aims to describe and compare experiences of health, quality of life and work ability at least 18 months after sustaining SPT at childbirth. Furthermore, we aim to explore if, how and to what extent maternal morbidity caused by SPT affects daily life and work ability.
To explore how women with maternal morbidity due to SPT conceptualize their problems in relation to their work ability.
To explore how women with persistent maternal morbidity due to SPT experience their contacts with health care services 18 months to five years after childbirth.
To describe work capacity at least 18 months after the onset of a third or fourth degree obstetric rupture and to identify risk factors for reduced work capacity.
To describe health problems at least 18 months after the onset of a third or fourth degree obstetric rupture and to identify risk factors for reduced quality of life.
The research project collects material consisting of both quantitative and qualitative data. The recruitment of participants will take place at national level through social media and interest groups.
In studies 1 and 2, interviews were conducted with a sample of women who have persisting health problems after SPT. The interview questions concerned the women's experience of daily life and their ability to work, but also whether and how they have adapted their situation. An important secondary finding in the interviews was the women's contacts with the healthcare system, which is examined in study 2. The interviews were conducted via a digital meeting tool and data collection was completed in spring 2021 (study 1) and spring 2022 (study 2).
Inclusion and exclusion criteria for studies 1 and 2
We included adult women (over 18 years) women who had given birth vaginally to at least one live-born child complicated by SPT, irrespective of vaginal delivery mode in the timeframe of January 2016 until June 2019. Further, women who had finalized their parental leave period and had returned to work, were searching for work, studying or on sickness cash benefit were included. Additionally, only women with self-perceived persisting health problems were included. Women who sustained a SPT giving birth to a stillbirth or who´s child died within 28 days postpartum, women who still were on parental leave or pregnant women were excluded.
Studies 3 and 4 are cross-sectional studies where data are collected using a web-based questionnaire. The questionnaire contains background questions and validated instruments aimed at mapping pelvic floor disorders and estimating quality of life and work ability. Data collection is completed and data analysis is ongoing (status: March 2024).
Inclusion and exclusion criteria for studies 3 and 4
Inclusion criteria are adult women (over 18 years) who have suffered a SPT at least 18 months ago. They can participate regardless of the extent of existing health problems related to the laceration or whether they have undergone reconstructive surgery. Women who have sustained a SPT giving birth to a stillbirth or who´s child died within 28 days postpartum, women who still are on parental leave or pregnant women will be excluded.
Study 1 is a grounded theory study and study 2 analyzes interview data using qualitative content analysis.
Studies 3 and 4 will be analyzed using parametric and non-parametric statistics. Furthermore, multiple logistic regression analysis will identify potential risk factors for reporting lower quality of life (study 4) or lower work ability (study 3).
All steps of the studies follow the ethical recommendations of the Helsinki declaration and collected data are only accessible to the research group. Each participant will be labelled with a study code. Any personal information, such as names or personal ID-numbers, are kept separate from data sets in a locked space at Umeå university that only the principal investigator has access to. No email addresses or IP addresses are stored in the online survey to protect the anonymity of the participant. Additionally, personal data will be stored and handled according to the General Data Protection Regulation, GDPR. According to ethical guidelines, all collected data will be stored for 10 years.
To further protect the identity of participating women, collected data will be presented on group level in the scientific articles. Neither personal characteristics nor citations will be presented that may reveal the identity of women partaking in the interviews.
All results generated in the project will be published in peer-reviewed and open access scientific journals. The project is estimated to result in up to six scientific papers, of which four studies are planned to be included in the doctoral student's thesis.
