Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

Abstract

Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how health personal, at four community hospitals in Mexico, perceive episiotomy, both before and after training in respectful maternity care, obstetric and neonatal emergencies. Methods This is a descriptive and interpretative qualitative study. We conducted Fifty-three pre and post-intervention (PRONTO© Program) semi-structured interviews with generalists, specialists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into six major themes surrounding their perceptions of episiotomy: as a predictable practice, as a prophylactic intervention, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of medical personnel. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this and other harmful obstetrical practices.