Background: The prevalence of sphincter rupture during childbirth has increased in Sweden from half percent to three percent from 1973 to 1993. Women who undergo planned home birth have sphincter injuries to a smaller extent than women who undergo planned hospital births. Objective: The purpose of this study was to describe women’s experience of the last stages of delivery during planned home birth. Design: Inductive content analysis of 150 randomly selected delivery reports. The delivery reports were gathered as a reply to an open question in a previously conducted survey.Findings: The woman´s confidence in the natural birthing process emerged as the overall theme of the delivery reports. Fourteen subcategories and five categories emerged during the analysis process: experience of support, physical experience, psychological experience, experience of birthplace and birth position and the woman’s awareness during birth. Conclusion: The support from the surrounding people was very important for the women and they felt calm and secure in the home environment. The women often gave birth in a birthing position that led to a reduced risk of perineal tears. Many risk factors for sphincter injuries were eliminated for the women who went thru planned home birth. For example the women often had experiences of prior deliveries and further no medical instruments were used during late stages of delivery in planned home births.

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline. / Bakgrund: Sfinkterskada är en allvarlig komplikation i samband med vaginal förlossning. Önskan om att undvika vaginal förlossning igen ses hos kvinnor som tidigare drabbats av sfinkterskada. Syfte: Syftet med studien var att ta reda på om det fanns riktlinjer gällande sfinkterskada i samband med förlossning vid Sveriges förlossningskliniker samt sammanställa och granska innehållet i riktlinjerna. Metod: Innehållsanalys med en kombination av deduktiv och induktiv ansats. Resultat: Av de 39 kliniker som svarade hade 31 riktlinjer gällande sfinkterskada. I riktlinjerna beskrevs vanligast förekommande riskfaktorer samt prevention med hjälp av perinealskydd. Läkaren ställde diagnos och utförde reparation av sfinkterskadan på operationsavdelningen. Komplikationer som samlagssmärta och anal inkontinens fanns beskrivet i riktlinjerna. Paracetamol och diklofenak var den vanligast förekommande smärtlindringen. Profylax som antibiotikabehandling och laxantia gavs av de flesta förlossningskliniker. Information till den nyförlösta kvinnan beskrevs. Uppföljning hos läkare, barnmorska och sjukgymnast rekommenderades efter fyra veckor till sex månader. Vid kommande graviditet och förlossning föredrogs kejsarsnitt. Slutsats: Riktlinjerna var uppbyggda på samma sätt och hade till stor del liknande innehåll. Författarna till föreliggande fördjupningsarbete efterfrågar en nationell riktlinje.