Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives: a cross-sectional study from China

Abstract

ObjectiveEpisiotomy is still performed widely by obstetricians and midwives in some Chinese maternity units, but the reasons are unknown. This study aims to determine the knowledge, attitude and experience towards the practice of episiotomy among obstetricians and midwives in China’s public hospitals and consider strategies to reduce its practice.MethodsA cross-sectional web survey using a self-administered questionnaire was conducted among obstetricians and midwives in 90 public hospitals in Henan Province, China.Results900 (82.21%) participants completed the questionnaire. Average knowledge level (4.15, SD=1.10) on complications and overuse was identified among participants. Episiotomy was performed more frequently in secondary hospitals than in tertiary hospitals (p<0.05). Senior clinicians were more likely to perform episiotomy than younger ones (p<0.05). Almost half of the clinicians (42.11%) considered the current rate of episiotomy (45%) to be right or too low. The most common reason for performing episiotomy identified by obstetricians (83.94%) and midwives (79.69%) was to reduce third-degree or fourth-degree perineal laceration. Both obstetricians (80.29%) and midwives (82.57%) agreed that the most significant obstacle to reducing the rate of episiotomy was lack of training on reducing perineal tears.ConclusionIn sum, episiotomy was driven by previous training, practitioners’ experience and local norms rather than the latest medical evidence. Clinicians in secondary hospitals and senior clinicians are key training targets. It is urgent to improve current clinical policies and surgical procedure guidelines for obstetricians and midwives regarding episiotomy.

Prophylactic antibiotic use during labor and delivery in China: a nationwide, multicenter, hospital-based, cross-sectional study

“…12) [ 12 ] but superseded this recommendation in 2021 [ 23 ]. Although WHO does not recommend episiotomy for women undergoing spontaneous vaginal birth [ 24 ], it was a common practice in this study (32.3%), and the main reason behind it is to reduce potential severe perineal trauma, according to another study carried out in China [ 25 ]. Fear of adverse outcomes may contribute to lower adherence to antibiotic prophylaxis guidelines [ 26 ].…”

Episiotomy at the Asha’ab obstetric emergency center, Aden, Yemen: Prevalence, clinical profile, and complications

“…Studies indicate that the main reasons for the high rates of episiotomy in poor-and middle-income countries are lack of training, local national norms, and fear of severe perineal injury [23]. In Yemen, the civil war has prompted many skilled healthcare workers to emigrate from the country in search of better salaries and more secure conditions [24].…”

Effect of Rosemary Cream on Episiotomy Wound Healing in Primiparous Women: A Randomized Clinical Trial

“…The World Health Organization [WHO] has recommended episiotomy for less than 10% of vaginal deliveries and has limited its use to complicated vaginal deliveries, such as breech, shoulder dystocia, forceps/ vacuum delivery, fetal distress, wounds caused by female genital circumcision, and minor repair of anal sphincter injuries. However, the rate of episiotomy is still high in developing countries [5]. The rate of episiotomy was reported to be 41.5% in a study conducted in Shahroud, Iran, from 2014 to 2015 [6].…”

“…Episiotomy is a type of surgical incision that does not reduce the risk of severe perineal rupture, rather it increases the risk of such complications as perineal rupture, perineal pain, wound infection, and postpartum hemorrhage, and subsequent dyspareunia [5].…”