Midwives’ Perceptions, Experience and Reasonsfor Routine Episiotomy in Maternity Teaching Hospitals - Khartoum State- Sudan

Abstract

Background: Midwives have a crucial role in caring for women with normal labor. Routine episiotomy has no benefit and its used is not scientifically supported. Understanding midwives' perception and experiences would target the situation.This study aimed to explore midwives' perceptions,experience and reasons for routine episiotomy. Methods:A cross-sectional exploratory study was conductedin three maternity teaching hospitals in Khartoum state on 85 midwives recruited randomly and consented to take part in the study. A questionnaire was constructed for the purpose of the study, and data were collected by interview with midwives, on reasons for and rate of episiotomy and perceptions of midwives were recorded on a Likert scale. Suitable statistical methods were used. Results:A high percentage of the study participants 64(75.4%) were nurse midwives had a midwifery certificate. With long years of experience more than ten years 54 (63.5%).The rate of episiotomies was high 73(85.9%).The midwives reported nine clinical reasons , mainly preventscomplications, Prevents the perineum tears and helping birth (93%, 90%, 84.7%) respectively.Midwives perceived that; episiotomy "speeds up the second stage of labor", "prevent perineal tears and urinary and fecal incontinence", "Reduces fetal and maternal distress",shoulder dystociacomplications, bleeding,labor pain, instrument-assisted delivery and allow for easier suturing".There was a significant correlation between Midwives practice and their education with, P value =.001. Conclusion:The rate of routine episiotomy was high with Midwives misleading perspectives and views

Reasons for performing episiotomy during ectopic deliveries: An integrative literature review

“…Some studies have shown that fetal distress is one of the main reasons for performing an episiotomy 21 , which is consistent with several other findings 22,23,24 . In the Seijmonsbergen-Schermers et al study 21 , fetal macrosomia and other physical characteristics were criteria for performing episiotomy.…”

“…Seijmonsbergen-Schermers et al 21 state that episiotomy may be necessary to prevent fetal suffering in cases of prematurity and that it may also be necessary in cases of prolonged labor to facilitate a faster delivery, which is consistent with the findings of Masuda et al 25 and other studies [22][23][24]26 . This practice reduces maternal effort and prevents fetal distress, thereby facilitating labor 27 .…”

“…Carvalho et al 30 demonstrated that the technique is not associated with fetal distress or fetal characteristics, such as changes in APGAR or weight. However, other authors [21][22][23][24] argue that it is a crucial procedure for situations in which there is fetal distress. Furthermore, it is important to note that there is evidence challenging this claim.…”

“…Health professionals may view episiotomy as a means to expedite labor and reduce crowding in delivery rooms 21 . A study conducted in Cambodia revealed a 94.5% episiotomy rate due to concerns over perineal lacerations, time constraints, and overcrowding 23 .…”

“…Other authors 26,27 suggest that the recurrent practice of episiotomy may be due to a lack of theoretical and practical knowledge about the physiology of the perineum and the expulsive period of labor. The education of health professionals 23 and their experiences and training also influence the decision to perform this procedure.…”