Influence of training in the use and generation of evidence on episiotomy practice and perineal trauma

Abstract

ObjectiveTo examine episiotomy practices before and after a multi-component intervention designed to support the use and generation of research evidence in maternal and neonatal health care.MethodsSet in 9 centers across 4 Southeast Asian countries, a retrospective survey was performed for 12 recommended pregnancy/childbirth practices and 13 outcomes of women in each center before and after intervention. Qualitative interviews were conducted to assess staff awareness and experience in evidence-based practice.ResultsThere were significant decreases in the rate of episiotomy, from 64.1% to 60.1% (risk difference [RD] –4.0; 95% confidence interval [CI], –5.8 to –2.2) for all women and from 92.2% to 80.7% (RD –11.5; 95% CI, –13.4 to –9.6) for nulliparous women. Severe trauma decreased from 3.9% to 1.9% (RD –2.0; 95% CI, –2.7 to –1.4) for all women and from 6.7% to 3.0% (RD –3.7; 95% CI, –4.9 to –2.5) for nulliparous women. The frequency of intact perineum increased from 12.4% to 15.6% (RD 3.2; 95% CI, 1.9–4.6) for all women and from 1.7% to 8.0% (RD 6.3; 95% CI, 5.0–7.5) for nulliparous women.ConclusionAn intervention based on understanding and using the best available evidence can result in significant improvements in care and health outcomes.

Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study

“…In this study, some centers participating in the survey reported increased episiotomy rates, because each center had implemented its intervention with varied emphases on specific practices, depending on the perceived needs. They identified a number of barriers to the practice of restrictive episiotomy, which included: fear of tearing, difficulty in repairing lacerations compared to episiotomies, lack of preparation of the perineum, applicability of the research conducted in a different population, lack of time and the need to train the young/newer staff (14) . There was also a change in obstetric practice in a randomized controlled clinical trial with 600 nulliparous women in Iran comparing perineal protection techniques (hands onintervention technique of perineal protection and hands off -expectant technique of perineal protection) by the reduction of perineal traumas.…”

The Use of Episiotomy in a Low‐Risk Population in The Netherlands: A Secondary Analysis

“…This finding suggests that other factors play an important role. One experimental study showed that educating midwives about evidence with respect to perineal management may reduce the incidence of episiotomy and increase the intact perineum rate . Our results may generate a debate among midwives about the indications for performing an episiotomy.…”

A pesquisa translacional e o cuidado perineal no parto: relato de implementação

“…Houve quedas na taxa de episiotomia e do trauma grave nas nulíparas (92,2% para 80,7% e 6,7% para 3,0%, respectivamente); além de aumento da frequência de períneo íntegro em nulíparas (1,7% para 8,0%). Os autores concluíram que uma intervenção educativa baseada na utilização de evidências científicas resulta em melhorias na prática da episiotomia e na redução da taxa de trauma perineal entre as mulheres nulíparas (HO et al, 2010).…”