Ignorance of anatomy 'frightening'

By MARTIN JOHNSTON health reporter

Junior doctors and midwives have a "frightening" ignorance of the anatomy involved in a small incision often made to ease childbirth, a specialist says.

Dr Philip Beattie and Dr Paul Robinson surveyed a sample of colleagues at National Women's Hospital about which muscles should be cut in an episiotomy. This is an incision in the perineum, the tissue between the vagina and the anus, and it is stitched up after birth.

At National Women's in 2000, it was performed on 1367 women - of which 23.8 per cent gave birth vaginally.

Long-term complications of episiotomy and spontaneous tearing of the tissue can include faecal and urinary incontinence, and pain during sexual intercourse.

Of the 71 health workers and students who were asked which of nine muscles should be cut, only five gave the correct answer - the superficial transverse perineal muscles and the bulbocavernosus.

Three of the 41 midwives answered correctly, two of the 20 registrars and house officers, and none of the 10 medical students.

Dr Beattie, an obstetrician-gynaecologist, said yesterday that the survey, published as a letter in the latest Medical Journal, revealed a lack of basic knowledge. Practitioners' knowledge of what they were doing was "quite frightening".

"We are concerned that practitioners may be performing the episiotomy procedure incorrectly, and failing to identify and correctly repair cut or torn muscles."

But tutors of doctors and midwives said getting the names wrong did not prove practitioners were performing the procedure incompetently.

"We need to lift our game in terms of formal training and standards of practice," Drs Beattie and Robinson wrote.

Dr Beattie said in light of the survey he had simplified his lectures, to doctors and midwives, on the perineum.

Overseas research had found that up to 5 per cent of women who delivered babies vaginally later suffered altered bowel function, through damage to nerves or the structure of the anal sphincter.

A significant number of women returned to hospital for corrective surgery to a badly repaired episiotomy or vaginal laceration, although no statistics were collected, Dr Beattie said.

Professor Peter Stone, head of obstetrics and gynaecology at the Auckland Medical School, said he would be worried by the study only if it revealed a lack of knowledge among senior registrars. It was unclear if it did.

National Women's provided practical training to ensure the doctors' and midwives' skills in pelvic repair were up to scratch, he said.

Jackie Gunn, the Auckland University of Technology midwifery programme leader, said midwives only infrequently performed episiotomies, so she was not surprised they were unfamiliar with the muscle names.

The Nursing Council chairwoman, Judy Kilpatrick, said midwives ought to be able to name the muscles, but the council had received no complaints of badly handled episiotomies.

nzherald.co.nz/health