Women's experiences of their perineum following childbirth: expectations, reality and returning to normality.

Abstract

Women's experiences of their perineum following childbirth: expectations, reality and returning to normality The aim of the study was to explore the feelings, perceptions and experiences of women in relation to their perineum following childbirth in the early postnatal period. A grounded theory approach was used for collecting and analysing data from eleven diaries and seven interviews with broad questions about how the perineum, following a vaginal birth, affected the way daily living activities were carried out. Initially purposeful sampling was utilised to recruit women but as important issues emerged recruitment continued through theoretical sampling. Following childbirth women expressed a strong desire to get back to normal reflecting the core theme `striving for normality'. Normality in this context meant doing normal things and feeling like their normal selves. Much of what the women described doing during the early postnatal period was related to achieving that goal and linked to the following categories: `preparing for the unknown', `experiencing the unexpected', `adjusting to reality', `getting back to normal' and `recovery of self'. The main theoretical idea that emerged from this study and derived directly from the data is that: If women are able to successfully adjust to their new and often unexpected reality after the birth of their baby, and begin to reclaim their selves and their world, then they experience a return to their normality. The data demonstrates and clarifies three distinct but related aspects. Firstly, coping with the unexpected consequences of childbirth meant that the women frequently made adjustments to how they carried out essential activities such as walking, sitting and passing urine, in order to try and carry on as normal. The second aspect related to daily activities that were not essential but which women felt necessary to undertake because of social expectations. These included housework and shopping. The third aspect related to how the women felt about their body as a result of the perineal trauma they sustained, and what helped them to feel like their `normal selves' again. These interrelated stages form a framework that reflects Maslow's lower order, hierarchy of needs, within the humanistic psychology paradigm. Implications for practice include the need to improve care in areas of preparing women having their first baby, listening to women as part of the assessment of perineal pain following birth and the need for continuity of care from the same midwife in order for women to appropriately manage their perineal experience.