Perception regarding restricted episiotomy: A qualitative study

Abstract

Background/Aim: Episiotomy is a planned surgical incision in the perineum and posterior vaginal wall in the second stage of labour to enlarge vaginal opening during delivery. It is one of the most commonly preferred obstetric operation during delivery since 1920 and practised routinely in most of the developing countries till today. Restricted practice refers to episiotomy reserved for situations where there is clear indication to perform the procedure. World Health Organisation (2018) recommends restricted practice of episiotomy. Voluminous literature highlights extensive disagreement about the necessity and benefits of the procedure. Even though the pendulum has swung back the practice of liberal episiotomy is still higher than the expected rate. Role of decision ends up in the midwives/ obstetrician’s hands who conduct the delivery. Limited researchers have examined the motive behind practicing liberal episiotomy. In this context a qualitative study was conducted to address the issues from midwives/obstetrician’s own perception regarding restricted practice of episiotomy. Materials and methods: This is a phenomenological approach qualitative study using the thematic analysis. The participants included 15 midwives and 8 obstetricians with minimum experience of one year selected by purposive sampling and attended semi structured interview. Results: The themes emerged after data analysis are Negative impact on self and maternal morbidity and Inadequate readiness. Conclusion: The subjective opinion of midwives/obstetricians could identify reasons behind the reluctance to give up the age old practice and threw light in to the gap that exists in practice and scientific evidence. Conscious effort may be taken by the midwives /obstetricians to adopt the best evidence based protocol and deliver quality care.