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Perineal Care: An International Issue
Quay books, November 2004, Pages: 235
The idea for this book evolved over several meetings with colleagues from the University of Birmingham to discuss the launch of the perineal tear assessment tool described in Chapter 6. The background to the development of the tool highlighted that practice to prevent, minimise and manage perineal trauma continued to persist uninformed by evidence of effectiveness, and with little opportunity for women to discuss how they could contribute to their care. It was also clear that limited attention was given to ensure that those caring for women in the immediate postpartum period were trained to identify accurately the extent of trauma sustained or, if suturing was required, to use methods and materials which could enhance postnatal recovery. As a consequence, hundreds of thousands of women who give birth each year in the UK and worldwide, continue to endure pain and associated morbidity which may have been prevented or minimised. Whilst this morbidity may not be life-threatening, the short and longer-term consequences of unidentified or inadequately repaired and managed perineal trauma can be significant for the woman, her infant and her family. With this as the background, we felt that a book which specifically focused on this neglected aspect of women’s health was pertinent.
Each chapter has been written by authors expert in their field and recognised internationally as such. Chapters are included on the anatomy of the pelvic floor, the management of perineal trauma, episiotomy, prevention of perineal trauma, the development of a perineal tear assessment tool, health after childbirth, and postpartum care of the perineum. Some chapters present evidence for the first time. For example, the chapter on episiotomy includes latest data on episiotomy rates worldwide. A chapter specifically devoted to the issues faced by women who give birth in developing countries, such as obstetric fistula, is also included, highlighting the very real danger pregnancy and childbirth still present to millions of women in the twenty-first century. That maternal mortality and major morbidity continue to affect such huge numbers of women worldwide must be addressed if the lives of current and future generations of women and their families are to improve. We make no apologies for including this as our opening chapter.
Whilst the book covers all aspects of perineal care, it is possible to read each chapter in isolation. A quick reference guide is also included to enable readers more readily to find specific information of interest. We hope that you will find the book a valuable resource.
List of contributors
Foreword by Gillian Fletcher
Introduction: guide to chapters
1 Reproductive issues in less developed countries
2 Women’s health after delivery
3 Anatomy of the pelvic floor
4 The management of perineal trauma
5 Episiotomy: the unkindest cut that persists
Ian D Graham and Christine Davies
6 Perineal tear assessment and the development of the Peri-Rule™
Susan Tohill and Alison Metcalfe
7 Prevention of obstetric perineal trauma
Ranee Thakar and Abdul Sultan
8 Postpartum management of the perineum
Christine Henderson and Debra Bick