(2015) found a relationship between second-degree and more severe perineal tears with symptoms of depression at one month postpartum and continuing to three months postpartum, however, the study of psychological outcomes in research into perineal trauma is limited. It may also negatively affect a woman's day-to-day quality of life and maternal relationships with their infant, partner and family. Depending on the degree of perineal trauma, it can cause pain, urinary and faecal incontinence, and sexual dysfunction. Perineal trauma following childbirth has been associated with a number of physical and psychological complications. In the United Kingdom (UK), 22% of women having a vaginal birth undergo episiotomy and 3.5% experience a third‐ or fourth‐degree tears. Episiotomy rates have been reported to be around 18.1% in primiparous women and 5.6% in multiparous women. The reported rates for multiparous women are more consistent with second-degree tears reported to be 34.8–39.6% and third- and fourth-degree tears 1.8–2.8%. Reported rates of perineal trauma for primiparous women vary from 35.1–78.3% for second-degree tears and 5.1–8.3% for third and fourth degree tears that involve obstetric anal sphincter injuries (OASIs). It has been estimated that 85% of women having a vaginal birth will experience perineal trauma, and at least 70% of these will experience suturing of the wound. Perineal trauma, involving either naturally occurring tears or episiotomy, is common during childbirth. Assessment and management of physical symptoms in the postnatal period may play an important role in reducing both physical and psychological postnatal morbidity. There was some evidence of a direct association between perineal trauma and PTS symptoms but no evidence of a direct association between perineal trauma and depression or anxiety. Women who experienced perineal trauma were more likely to experience physical symptoms, and the more physical symptoms a woman experienced the more likely she was to report having postnatal depression, anxiety and PTS symptoms. There was no evidence of association between perineal trauma and satisfaction with postnatal care, although there was strong evidence that satisfaction with labour and birth was associated with 16% reduced adjusted odds of depression and 30% reduced adjusted odds of PTS symptoms. Women who experienced perineal trauma reported having more postnatal physical symptoms (adjusted proportional odds ratio 1.47, 95%CI 1.38 to 1.57, p-value < 0.001), were more likely to report PTS symptoms (adjusted OR 1.19, 95%CI 1.04 to 1.36, p-value 0.010), and there was strong evidence that each unit increase in the physical symptoms score was associated with between 38 and 90% increased adjusted odds of adverse psychological symptoms. Nearly three quarters of women experienced some degree of perineal trauma. Regression models were fitted to explore the associations. Physical symptoms were derived from a checklist and combined to produce a composite physical symptoms score. Symptoms of depression, anxiety, and post-traumatic stress (PTS) symptoms were assessed using validated self- report measures. A total of 4,578 women responded to the survey, of which 3,307 had a vaginal birth and were eligible for inclusion into the analysis. This study was a secondary analysis of data from a cross-sectional population-based survey of maternal and infant health. This study aimed to determine the associations between childbirth related perineal trauma and psychological outcomes reported by women three months after giving birth and to explore factors that could mediate relationships between perineal trauma and maternal psychological outcomes. Perineal trauma, involving either naturally occurring tears or episiotomy, is common during childbirth but little is known about its psychological impact.
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