• Holly Priddis, Hannah Dahlen, and Virginia Schmied.
• School of Nursing and Midwifery, College of Health and Science, University of Western Sydney, Penrith South DC, New South Wales, Australia. hollyprm@hotmail.com
• J Adv Nurs. 2013 Apr 1; 69 (4): 748-59.

AimsThis article presents a meta-ethnographic synthesis of studies on women's experiences of sustaining a third or fourth degree tear during childbirth.BackgroundIt has been reported that for women who sustain third or fourth degree perineal tears (severe perineal trauma) some may experience extensive physical and psychological outcomes.DesignA meta-ethnographic synthesis.Data SourcesThe CINAHL, PubMed, Scopus, MD Consult, and SocIndex with Full Text databases were searched for the period January 1996-June 2011. Out of 478 papers retrieved four met the review aim.Review MethodsA meta-ethnographic synthesis approach was undertaken using analytic strategies and theme synthesis techniques of reciprocal translation and refutational investigation. Quality appraisal was undertaken using the Critical Appraisal Skills Programme (CASP) tool.FindingsFour qualitative papers were included, with three major themes identified: 'I am broken and a failure', 'Dismissed, devalued and disregarded', and 'The practicalities of the unpredictable perineum'.ConclusionThere is evidence to suggest that for women who experience severe perineal trauma during childbirth the physical and psychological outcomes can be complex, with some women experiencing social isolation and marginalization due to their ongoing symptomatology. Severe perineal trauma appeared to affect not only physiological and psychological well-being but also altered the women's understanding of their identity as sexual beings. Health professionals should be mindful of the language that they use and their actions during suturing and the postpartum period to avoid causing unnecessary distress.© 2012 Blackwell Publishing Ltd.

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