Evaluation of evidence-based episiotomy practice by midwives

Abstract

Research-based practice in nursing and midwifery is regarded as a means of ensuring that quality care is provided by integrating individual clinical expertise with the best available clinical evidence from systematic research. Previous studies indicate that few midwives strive to achieve their role of safe motherhood by helping women and their families through the pregnancy and childbirth process using research-based practice. The study documents the practice of episiotomy by midwives in an urban setting. This is a cross-sectional qualitative and quantitative descriptive study. All midwives working in the labour ward at Pumwani Maternity Hospital in June–July 2009 were eligible for the study. A standard questionnaire was used to collect data regarding socio-demographic characteristics, professional training and evidence-based knowledge. Consenting and qualifying midwives were eligible for study. In-depth interviews were conducted among key informants over the same period. Data were analyzed using Statistical Package for the Social Sciences (SPSS). The most common types of episiotomy preferred by the midwives was medio-lateral and midline. Various factors were reported to have influenced the midwives practices: very tight perineum, breech presentation, premature labour, female genital mutilation, instrumental delivery and status of the fetus. In-depth interviews demonstrated lack of specific guidelines on specific procedures, personal attitudes and inadequate administration support. The study recommends an urgent need to put in place modalities to ensure that guidelines are developed and used appropriately in order to standardize provision of services.