Womens Preference of Birth after a Previous 3rd Degree Tear - Essay Example

Women’s Preference of Birth after a Previous 3rd Degree Tear Name Institution Name Introduction A women having her first vaginal birth is prone to experience a tear in her perineum; the region between her vagina and the anus. The tear might range from a small abrasion or nick to a deep laceration that has effect on the pelvic floor muscles (Aukee, Sundstrom & Kairaluoma, 2006; Hudelist et al. 2005). These tears are classified into first degree/superficial tear, second-degree lacerations, third degree lacerations, and fourth degree tear (Scheer, Thakar & Sultan, 2009). This paper singularly focuses on third degree laceration; this is a tear in the vaginal tissue, perineal skin, perineal muscles that extends into the anal sphincter. Some women who experience third degree tear have been found to suffer from severe perineal trauma, which might escalate into significant morbidity coupled with pain, faucal incontinence, and dyspareunia. Using a focused clinical question, this paper proposes to conduct an extended research into women preference of birth after a previous 3rd degree tear. Focused clinical question is a vital tool that helps clinicians to get evident solutions to various clinical problems (Eskandar & Shet, 2009). For instance, it has been found to simplify the work of medical experts offering care to their patients. They are also used as a source for literature searching in order to establish the relevant external evidence from research (Aukee, Sundstrom & Kairaluoma, 2006). Similarly, the research evidence obtained is critically appraised for validity and generalization. The evidence that is deemed best is then used alongside clinical expertise and the patient’s viewpoint to plan for care. Lastly, the performance is then evaluated through a self-reflection process, peer assessment and/or audit. Given this understanding, this research proposal provides a plan for conducting an in-depth study to establish the preference of women having birth after a previous 3rd degree tear at Veroxy Nursing Home. Veroxy Nursing Home is a speculative nursing home that offers midwifery services to their clients. Consulting with colleagues Less information is documented with regard to the likelihood of women going in for another pregnancy after having a previous 3rd degree laceration (Eskandar & Shet, 2009; Hudelist et al. 2005). During a grapevine at our lunch break, we were discussing about a woman who had had her first child at Veroxy Nursing Home. The woman had suffered a severe third degree laceration and she been sutured by obstetricians (Aukee, Sundstrom & Kairaluoma, 2006; Pang et al., 2008). Through this grapevine, we consulted colleagues including midwives, obstetricians and well other doctors (Fitzpatrick et al., 2000). Through this grapevine, we identified a focused clinical question in midwifery, which could benefit from additional research and thus led to the developing the following clinical question: What methods of birth do women who have previously experienced a third degree tear prefer? Focused clinical question What methods of birth do women who have previously experienced a third degree tear prefer? A focused clinical question is only relevant when it is beneficial to both patient and clinicians; for instance, it should have direct relevance to the patients’ problem and also must be phrased in a manner that directs the search to best and precise answers. Description of a search strategy identifying existing literature related to the focused clinical question Severe 3rd degree tear during vaginal birth can happen spontaneously or due to obstetric intervention. This severe perineal trauma comprises of the injuries to the perineum that involve anal sphincter complex which is further classified into 3a, 3b, and 3c with respect to the degree to which the external and internal sphincter is involved (Aukee, Sundstrom & Kairaluoma, 2006). The risk factors for severe perineal trauma include: parity, maternal age, previous experience of 3rd degree tear, fetal weight, gender of the fetus, and abnormal collagen synthesis. Some literature has established that Asian women are highly susceptible to sustaining severe perineal trauma when giving birth (Eskandar & Shet, 2009; Hudelist et al. 2005). Other risk factors include episiotomy, prolonged second stage labour, obstetric emergencies like shoulder dystocia, instrumental birth, and birth position during second stage (Scheer, Thakar & Sultan, 2009). Some studies have suggested that women who had previously experienced 3rd degree tear fear experiencing a subsequent pregnancy and birth; this is particularly based on the risk of sustaining subsequent 3rd degree tear given the fact that such women require a caesarean section or episiotomy (Fitzpatrick et al., 2000). Accordingly, experts I this area have established that some women who previously experienced severe perineal trauma prefer subsequent virginal birth regardless of the fears regarding recurrence of the risk (Rhona et al., 2006). Various literatures have been documented with regard to 3rd degree tear, for instance, Medline, CINAHL, JCU, PsychLIT, EBSCO host databases have rich information. These databases have far-reaching information with regard to the search topic and with simple search of key words provide a variety of nursing and allied health journals (Aukee, Sundstrom & Kairaluoma, 2006; Hudelist et al. 2005). The key words here include: third degree tear, routine caesarean, midwives, care, maternity, perineal trauma, complications of third degree, and complication of caesarean (Eskandar & Shet, 2009; Pang et al., 2008). Inclusion and exclusion criteria will be used to determine the eligibility of the articles to be used; for instance, relevant studies will be included while at the same time no study will be excluded without thorough assessment (Fitzpatrick et al., 2000). The three main steps for journal article selection will include (Rhona et al., 2006): Titles and abstracts – if this will be found irrelevant to the research topic; the research will automatically be excluded (Scheer, Thakar & Sultan, 2009). Assessment of full text to determine its relevance (Scheer, Thakar & Sultan, 2009) Include only most recent and relevant studies by ensuring up to date clinical practice, no older than 7 years; this is due to the fact that recent studies will provide a clear picture with regard to the research topic. However, it is important to note that there is scanty information documented on the preferred birth method for women who have previously experienced third degree tear (Eskandar & Shet, 2009; Pang et al., 2008). Most articles regardless of having massive information about third degree tear, nothing is directly or indirectly relevant to the preferred birth method for women who have previously experienced severe perineal trauma (Aukee, Sundstrom & Kairaluoma, 2006; Hudelist et al. 2005). Due to the lack of any published evidence, the aforementioned focused clinical question transformed into a research question; for this reason, this paper proposes to determine the preferred birth method for women who have previously experienced severe perineal trauma (Fitzpatrick et al., 2000). Problem statement including significance of the problem to midwifery care Problem statement Determine the preferred birth method for women who have previously experienced third degree tear at Veroxy Nursing Home. Significance of the study This study is relevant to midwifery; the midwifery society will gain extensive understanding on the various birth method preferred by women who have previously experienced third degree tear (Fitzpatrick et al., 2000). Research Aim To determine the preferred birth method for women who have previously experienced third degree tear Research question What methods of birth do women who have previously experienced a third degree tear prefer? Research methodology The following section discusses the research methodology Research approach The two main approaches to research used in any research activity are deductive approach and inductive approach (Fitzpatrick et al., 2000; Pang et al., 2008). The deductive approach particularly used when the researcher forecasts the outcomes of the research and then acquires the knowledge about the forecast, which either disapproves or supports the forecast (Aukee, Sundstrom & Kairaluoma, 2006; Hudelist et al. 2005). This approach is mostly related to quantitative research. The inductive approach on the other hand makes use of observations to come up with facts about the research problem (Eskandar & Shet, 2009). In this regard, the approach focuses on specific measures and detection of regularity, formulation of the hypothesis together with the development of theories and general assumptions. This approach is mainly used in qualitative research (Aukee, Sundstrom & Kairaluoma, 2006; Pang et al., 2008). The researcher proposes to use inductive approach whereby he will primarily use interviews to come up with facts in order to acquire broader and relevant data as well as providing a comprehensive understanding of the topic (Fitzpatrick et al., 2000; Pang et al., 2008). The use of inductive approach will help the researcher to have a broader basis for understanding the search problem in order to come up with more reliable results (Rhona et al., 2006). Research Strategy The seven known and accepted research strategies are: survey, experiment, case study, action research grounded theory, ethnography and archival research (Eskandar & Shet, 2009; Hudelist et al. 2005). “The preferred birth method for women who have previously experienced third degree tear” research will use survey strategy. Survey strategy will be very instrumental in assessing the case study approach (Aukee, Sundstrom & Kairaluoma, 2006; Pang et al., 2008). Similarly, it will empower the researcher to manage and have control over the research activity through the sampling techniques, which are very essential in accessing the research participants (Fitzpatrick et al., 2000). Similarly, due to time constraints that are encountered during the research process, the survey strategy will give the researcher an efficient and quick way of obtaining qualitative data within the shortest time possible (Rhona et al., 2006). In a nutshell, a descriptive qualitative study will be used (Scheer, Thakar & Sultan, 2009). Data collection Given the above strategy that will be used in this study, the researcher will employ a qualitative data collection methodology (Fitzpatrick et al., 2000; Pang et al., 2008). For this matter, the data collection process will include both numeric and verbal instruments that will be divided into primary and secondary data (Aukee, Sundstrom & Kairaluoma, 2006). In “the preferred birth method for women who have previously experienced third degree tear” research study, the researcher will conduct and extensive document review to be obtained from various sources that are directly or indirectly related to the research topic including books, internet websites, journals and other publicly available records (Eskandar & Shet, 2009; Hudelist et al. 2005). Consequently, the survey strategy will be adopted and thus the researcher will develop semi-structured interview questions (Rhona et al., 2006). Semi-structured Interviews: this research instrument is essential in obtaining extensive and vast information about the research participants that is vital in establishing information about the research problem (Aukee, Sundstrom & Kairaluoma, 2006; Hudelist et al. 2005). The either interview can have open-ended or closed-ended (Rhona et al., 2006). In this particular research, the researcher will use both open-ended and closed-ended interview to obtain vast information with regard to the preferred birth method for women who have previously experienced third degree tear (Fitzpatrick et al., 2000; Hudelist et al. 2005). Sample Size From the above data collection methodology, the researcher will use stratified sapling to recruit research participants (Rhona et al., 2006). For instance, the research will use Veroxy Nursing Home Severe Perineal Trauma database to identify the participants (Aukee, Sundstrom & Kairaluoma, 2006; Pang et al., 2008). The database will provide contacts for various women who have previously experienced third degree tear for the last five years (Fitzpatrick et al., 2000). This will provide the researcher with the relevant population to choose from (Scheer, Thakar & Sultan, 2009). These women will be contacted by directly calling them to request for their participation in the study (Eskandar & Shet, 2009; Hudelist et al. 2005). A population of 20 women will be used in this research; after receiving participation acknowledgment via the phone, the researcher will schedule one on one meeting with each of these women. The semi-structured Interview questions i. How old are you? ii. How old were you when you first experienced third degree tear? iii. Was it your first birth? Yes/No iv. Have you ever had any complications from the third degree tear? Yes/No v. Have you ever had another birth after the third degree tear? Yes/No vi. If yes, which birth method was most preferable? Caesarean/Vaginal vii. If not, do you consider having another birth? Yes/No viii. If yes, which birth method would you prefer? Caesarean/Vaginal ix. If not, what are your reasons? x. What would birth method would you recommend for a woman who has previously experienced third degree tear? Data analysis This section will be dedicated to analysing the findings of this research and to bring a full understanding with regard to the preferred birth method for women who have previously experienced third degree tear at Veroxy Nursing Home. The semi-structured interview will be used to collect qualitative data (Aukee, Sundstrom & Kairaluoma, 2006; Hudelist et al. 2005). The responses from participants will be captured using a digital recorder. The researcher will then transcribe the data into a word document (Rhona et al., 2006). The statistical data that will be obtained from the transcripts will be analysed using SPSS v.19. The analysed results will be presented in tables and charts. The interview questions support each other and hence their findings and analysis easy (Fitzpatrick et al., 2000). Limitation of the research methodology i. The entire research is based on 20 women participation that had experienced third degree tear at one hospital; the data that will be acquired will not present a holistic picture as to which method is preferable for women who had previously experienced third degree tear. ii. Controlling the participants to remain within the research context (Aukee, Sundstrom & Kairaluoma, 2006) iii. The research topic is wide which demands for substantial amount of time to be completed; this is a limited resource and hence it is likely to limit the research process. Ethical consideration This researcher will be conducted in a morally and ethically acceptable manner and in accordance with NHMRC guidelines (Scheer, Thakar & Sultan, 2009). For instance, whereby the researcher will ensure that all research ethical codes are well taken into consideration and adhered to (Eskandar & Shet, 2009). Accordingly, participants will be informed of the main objectives of the study and that their participation will be voluntary (Fitzpatrick et al., 2000). The confidentiality of participants together with their responses will be treated discretely and will not be compromised at any cost (Aukee, Sundstrom & Kairaluoma, 2006). Similarly, qualitative research will be treated with absolute discretion; the participants will be informed in advance of what they will expect in the interview and more importantly, interview recordings will be allowed after the participant gives an informed consent (Fitzpatrick et al., 2000; Pang et al., 2008). Furthermore, the researcher has full knowledge of intellectual property rights, thus any material that will be borrowed from secondary sources will be fully cited in text and in the reference list (Aukee, Sundstrom & Kairaluoma, 2006). Lastly, the researcher will be strict with the research process to make sure that honesty prevails at all times (Eskandar & Shet, 2009). Timeline, budget and dissemination plan Timeline and dissemination plan The research will take three weeks; in the first week, the researcher will conduct an intensive document analysis with regard to the research topic and come up with a research proposal for the research (Scheer, Thakar & Sultan, 2009). For instance, different readily available documents will be reviewed in order to have an inherent understanding of the previous works on the research topic (Eskandar & Shet, 2009). The researcher will review reports, journals, books as well as online libraries on third degree tear. Designing of the semi-structured interview questions and conduction of the main study together with main data, collection will be done in the second week. After the data collection, the researcher will conduct data analysis and write a dissertation plan. The fourth and last week, the researcher will compile the findings of the final report (see the table below) SN: Description of events WK0 WK1 WK2 WK3 1 Proposal of the research plan 2 Document Analysis 3 Data Analysis 4 Report Compilation Proposed Budget Quantity Price ($) Total Cost SPSS software CD 1 135 135 Internet Access 4 10 40 Digital recorder 1 100 100 Cell phone 1 150 150 Hired Laptop computer 1 60 60 Total 485 References Aukee, P., Sundstrom, H., & Kairaluoma, M. (2006). The role of mediolateral episiotomy during labor. Analysis of risk factors for obstetric anal sphincter tears. Acta Obstetricia et Gynecologica Scandinavica, 85(7), 856-860. Eskandar, O., & Shet, D. (2009). Risk factors for 3rd and 4th degree perineal tear. Journal of Obstetrics & Gynecology, 29(2), 119-122. Fitzpatrick, M., Behan, M., O’Connell, P., & O’Herlihy, C. (2000). A randomized clinical trial comparing primary overlap with approximation repair of third-degree obstetric tears. American Journal of Obstetrics & Gynecology, 183(5), 1220-1224 Hudelist, G., Gellen, J., Singer, C., Ruecklinger, E., Czerwenka, K., Kandolf, O., & Keckstein, J. (2005). Factors predicting severe perineal trauma during childbirth: Role of forceps delivery routinely combined with mediolateral episiotomy. American Journal of Obstetrics and Gynecology, 192(3), 875-881. Pang, M., Leung, T., Lau, T., & Chung, T. (2008). Impact of First Childbirth on Changes in Women’s Preference for Mode of Delivery: Follow-up of a Longitudinal Observational Study. Birth, 35(2), 121-128. Rhona, M., Colin, W., Michael, F., Leslie, D., & Colm, O. (2006). Outcome of Second Delivery after Prior Macrosomic Infant in Women with Normal Glucose Tolerance. Obstetrics & Gynecology, 107(4), 857-862 Scheer, I., Thakar, R., & Sultan, A. (2009). Mode of delivery after previous obstetric anal sphincter injuries (OASIS)—a reappraisal? International Urogynecology Journal, 20(9), 1095-1101 Read More