Mccarthy, R 2009, 'Protecting the perineum: Have we been duped by HOOP?' , British Journal of Midwifery, 13 (12) , pp. 779-781.

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Abstract

The maintenance of an intact perineum following vaginal birth is a fundamental objective of the midwife. Traditional techniques adopted to protect the perineum were evaluated by McCandlish et al’s (1998) pivotal ‘HOOP’ study some ten years ago. The findings have largely been interpreted as suggesting that the custom and practice ‘hand on’ approach, adopted by many midwives, was inconsequential in preventing perineal trauma. This finding has impacted practice significantly. Management of the perineum during the second stage of labour is now varied and largely dependant on the preference of the midwife in attendance. Consequently student midwives are taught an assortment of approaches but appear to lack clear understanding of the rationale, let alone evidence, on which their practice is based. Corresponding with changes in practice, there is local audit evidence to suggest that the incidence of significant perineal trauma, involving damage to the external anal sphincter, anal sphincter complex (external and internal anal sphincter) and in the worst cases also involving the ano-rectal mucosa, is increasing. Given the considerable implications of this, perhaps it is time to re-visit HOOP and challenge the notion that traditional protective measures are of little value in preventing substantial trauma.

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