Clinical Preparation and Intervention Fidelity
Bimonthly meetings of the entire study team took place in the three months prior to randomizing
patients, and monthly meetings were held during the first year in order to standardize the
consent process, the perineal techniques, assessment of all genital tract trauma, and collecting
complete data. Films, pictures and diagrams, role-playing, and demonstration followed by
counter-demonstration were used to facilitate discussion and attain consensus. After the first
year, quarterly meetings were held to revisit the consent process and study protocol, discuss
any problems or concerns of the midwives, and share updates on the study’s progress. Six
months after patient randomization began, a second midwife began attending periodic study
births, not as a caregiver