A Systematic Review of the Literature

Practices That Minimize Trauma to the Genital Tract in Childbirth: A Systematic Review of the Literature






Article 2. Practices That Minimize Trauma to the Genital Tract in Childbirth: A Systematic Review of the Literature

Conducted a systematic review of the literature to describe the practices that minimize trauma to the genital tract in childbirth. This type of research best fits in level I in the level of evidence scale described by Melnyk and Fineout-Overholt. Level I on this level of evidence scale refers to evidence from a systematic review or meta-analysis of all relevant randomized clinical trials (RCT). The purpose of this study was to describe the state of knowledge on reduction of trauma to the genital tract during childbirth, prior to planning a large randomized control trial of ways to prevent this kind of trauma.

Validity. The researchers incorporated in the review studies of various types and placed them in five categories including randomized control studies or quasi-randomized studies, non-randomized prospective studies, retrospective studies and analyses of large data sets, meta-analyses and opinions or descriptions of practice. The researchers identified a total of 77 papers and chapters including 25 randomized trials, 4 meta-analyses, 4 prospective studies, 36 retrospective studies, and 8 descriptions of practice from textbooks. The researchers provide a detailed description on the search parameters employed to find the articles relevant to the study. Listed in the report, are the key words used in the search, relevant to the topic. The researchers searched for publications using both computers and hardcopy material, and a list of data sources is provided.

At least two researchers read each of the publications used in this study, and summarized and assessed them for content and quality. The researchers do not provide a detailed description on methods or tools used to evaluate the quality of the articles used. Details of each publication were tabulated under headings including the citation, study design, the sample and methods used to choose and define the sample, outcomes measured and relevant results. Three categories of the studies used in the research represented primary research, and findings from these articles are summarized in tables in the report. These categories include randomized control trials or quasi-randomized studies, prospective non-randomized studies and retrospective studies and analysis of large data sets. The common outcome measure that appeared in most of the studies reviewed was perineal trauma. The levels of statistical significance of the results from each study were reported where applicable. Aggregate data was used in all the studies.

Results. The overall findings from the study were in favor of restricted use episiotomy. The study found out that the contribution of maternal attitudes and characteristics to intact perineum pends investigation. The results for this study were placed in categories of the different types of publications reviewed by the researchers. From the randomized control and quasi-randomized studies, it was evident that there is no particular advantage or disadvantage on overall rates of genital tract trauma in delivery in upright or recumbent position. The review does not elicit any relationship between the pushing method and perineal trauma. Findings from review of meta-analyses revealed that available evidence does not support routine performance of episiotomy.

Review of prospective nonrandomized studies revealed that despite a huge disparity in the sample sizes in the two studies reviewed, similar results were obtained whereby women directed to do forceful pushing with sustained breath holding in second stage of labor had higher rates of trauma. From the retrospective studies and data set analysis, there were wide variations in rates of genital trauma depending on geographical location and demographic characteristics among others. Under the category of Opinions and descriptions of practice, the study found out the common opinion is the avoidance of sustained Valsalva pushing and episiotomy and that the delivery of the baby should be between contractions with only slight pushing by the mother. In addition, rapid expulsion of the baby should be prevented through maintaining light pressure on the head as it crowns and that the anterior shoulder should be delivered first. The odds ratios and confidence intervals were independently listed in the tabulated results for each study where available.

Applicability, Strengths and Weaknesses. The main aspect in this research is to find out more information about genital trauma during delivery. This aspect is relevant in the nursing profession as it forms a basis for the improvement of nursing practices in the labor unit, and promotes better nursing care for mothers. This study forms a basis for the development of strategies to promote better outcomes among mothers in the labor unit. This research incorporates activities that nurses take part in on a day-to-day basis in their work in the labor unit.

The strengths of this research include the availability of a detailed description in the studies reviewed including the methodology applied in their selection, assessment and their placement into various categories. The presentation of results in tables is visually appealing and makes it easy to grasp the overall findings from the study. The weaknesses of the study include failure to describe the tools used to ensure the quality and validity of the publications reviewed in the study. The use of various categories of studies in the review makes the study more complex and increases the scope of the study. This affects the presentation of results and summarization of findings.


Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice. Philadelphia, P.A.: Wolters Kluwers/ Lippincott, Williams & Wilkins.

Renfrew, M. J., Hannah, W., Albers, L., & Floyd , E. (1998). Practices That Minimize Trauma to the Genital Tract in Childbirth: A Systematic Review of the Literature. Blackwell Science, Inc.