Abstract:
OBJECTIVE:to explore midwives' reasons for performing or avoiding episiotomies and motivation to change episiotomy practice in a large tertiary maternity hospital. DESIGN:using purposive sampling, three focus groups were conducted to achieve theme saturation. Open-ended questions elicited personal reasons for performing or avoiding episiotomy, information sources, and opinions about past and future practice trends. Sessions were audiotaped, and transcripts independently examined by three researchers who coded for themes. An iterative process was used to achieve consensus. Grounded theory was used to interpret data and to derive a theoretical framework for understanding the reasoning that influences episiotomy practice. SETTING:a high volume delivery unit in Singapore. PARTICIPANTS:20 of 79 licensed midwives, aged 28-70, who performed independent deliveries at the delivery unit. FINDINGS:participants recognised maternal, fetal and other factors affecting their own decision to perform episiotomies. Patient request, better healing, midwife's reputation and job satisfaction were cited as main reasons to avoid episiotomy. Key sources informing practice were past training, delivery experience, anecdotal learning and lack of a protocol. There was no consensus on current trends in episiotomy practice. There was an absence of recognition of individual roles in reducing episiotomy rates. Clinicians were perceived as having both positive and negative influence. CONCLUSIONS:midwives' reasons for performing episiotomies were attributed to midwifery training, fear of doing harm and perceived clinician expectation, and were not consistent with current international practice guidelines. Reasons for avoiding episiotomies were associated with patient-centeredness and job satisfaction. Midwives agreed on the need to reduce episiotomy rates. IMPLICATIONS FOR PRACTICE:with reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and experiences of midwives should also be incorporated into strategies to change episiotomy practice.
journal_name
Midwiferyjournal_title
Midwiferyauthors
Wu LC,Lie D,Malhotra R,Allen JC Jr,Tay JS,Tan TC,Ostbye Tdoi
10.1016/j.midw.2012.11.017subject
Has Abstractpub_date
2013-08-01 00:00:00pages
943-9issue
8eissn
0266-6138issn
1532-3099pii
S0266-6138(12)00226-4journal_volume
29pub_type
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