What Makes Episiotomy Rates Change?:A Systematic Review of the Literature

Abstract

BACKGROUND:Episiotomy is still a commonly used surgical intervention during birth in some parts of the world, such as the Middle East and Eastern Europe. Evidence supports the restrictive use of episiotomy, and this is reflected in policy statements and clinical practice recommendations. Internationally, various strategies have been used to change and reduce the incidence of episiotomy.AIM:To identify and describe the strategies and practices that have been used internationally to effectively reduce the rate of episiotomy.METHOD:We searched CINAHL, Medline, Scopus, PubMed and Nursing Consultant from 1980 to 2010 by using the keywords episiotomy, change, practice, midwife, routine use and evidence-based. A review of the literature was undertaken, which examined factors that facilitate the reduction in episiotomy rates.RESULTS:Two hundred articles were found, and after examination, only nine provided relevant data and are included in this review. The findings of this review are discussed under the following headings: impact of practice change on episiotomy rates, continuous quality improvement, implementing clinical guidelines, practice change (system change), and the impact of health beliefs and organizational culture. Strategies for changing practice that were identified focused on challenging rationales for current practice and on creating a social and organizational environments that encourage motivation and, therefore, are more effective in reducing episiotomy rates. The literature identified the importance of clarifying critical success factors before trying to implement change with regards to episiotomy usage.CONCLUSION:Greater efforts to reduce episiotomy rates are currently needed, particularly in countries with high rates. Researchers need to continue to examine the barriers to change and investigate approaches that promote clinician behavior change.

Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries

“…Over time, encouraged by the CNGOF as well as political and associative groups, each institution has relied on some of these initiatives to reduce episiotomy rates. The effectiveness of this methodology has also been evaluated positively in the international literature 15 , 42 , 43 . Finally, the reduction that we observed between 2016 and 2017 boosted the general downward trend (rate of change of about − 20%), showing the potential impact of the national debate about episiotomy practice in France 29 , 44 .…”

Magnitude of episiotomy practice and associated factors among women who gave birth at Hiwot Fana Specialized University Hospital, Eastern Ethiopia

“…Reducing the non-evidence-based practice of episiotomy is a global target in improving maternal health and their birthing experiences ( 27 , 28 ). A number of strategies have been suggested by international leading associations and communities.…”

Episiotomy practice and associated factors among mothers who gave birth at public health facilities in Metema district, northwest Ethiopia

“…Strategies for changing practice those were challenging on current practice of episiotomy and on creating social and organizational environments that encourage motivation are more effective in reducing episiotomy rates [ 14 ]. A systematic review and meta-analysis that was done on episiotomy recommend that there is an urgent need to explore reasons for and devise programs to reduce the apparent higher rates of episiotomies in low and middle income countries (LMIC) at their medical facilities [ 14 , 15 ].…”

“…Strategies for changing practice those were challenging on current practice of episiotomy and on creating social and organizational environments that encourage motivation are more effective in reducing episiotomy rates [ 14 ]. A systematic review and meta-analysis that was done on episiotomy recommend that there is an urgent need to explore reasons for and devise programs to reduce the apparent higher rates of episiotomies in low and middle income countries (LMIC) at their medical facilities [ 14 , 15 ]. Complications of episiotomies include accidental extension into the anal sphincter or rectum, damage to the Bartholin’s gland, unsatisfactory anatomic results such as skin tags, asymmetry or excessive narrowing of the introitus, vaginal prolapse, recto-vaginal fistula, fistula in ano, perineal pain that lasted an average of 5.5 days, oedema, increased blood loss, hematoma, infection and dehiscence [ 16 – 23 ].…”