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What factors influence midwives' decision to perform or avoid episiotomies? A focus group study.

Publication ,  Journal Article
Wu, LC; Lie, D; Malhotra, R; Allen, JC; Tay, JSL; Tan, TC; Ostbye, T
Published in: Midwifery
August 2013

OBJECTIVE: to explore midwives' reasons for performing or avoiding episiotomies and motivation to change episiotomy practice in a large tertiary maternity hospital. DESIGN: using purposive sampling, three focus groups were conducted to achieve theme saturation. Open-ended questions elicited personal reasons for performing or avoiding episiotomy, information sources, and opinions about past and future practice trends. Sessions were audiotaped, and transcripts independently examined by three researchers who coded for themes. An iterative process was used to achieve consensus. Grounded theory was used to interpret data and to derive a theoretical framework for understanding the reasoning that influences episiotomy practice. SETTING: a high volume delivery unit in Singapore. PARTICIPANTS: 20 of 79 licensed midwives, aged 28-70, who performed independent deliveries at the delivery unit. FINDINGS: participants recognised maternal, fetal and other factors affecting their own decision to perform episiotomies. Patient request, better healing, midwife's reputation and job satisfaction were cited as main reasons to avoid episiotomy. Key sources informing practice were past training, delivery experience, anecdotal learning and lack of a protocol. There was no consensus on current trends in episiotomy practice. There was an absence of recognition of individual roles in reducing episiotomy rates. Clinicians were perceived as having both positive and negative influence. CONCLUSIONS: midwives' reasons for performing episiotomies were attributed to midwifery training, fear of doing harm and perceived clinician expectation, and were not consistent with current international practice guidelines. Reasons for avoiding episiotomies were associated with patient-centeredness and job satisfaction. Midwives agreed on the need to reduce episiotomy rates. IMPLICATIONS FOR PRACTICE: with reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and experiences of midwives should also be incorporated into strategies to change episiotomy practice.

Duke Scholars

Published In

Midwifery

DOI

EISSN

1532-3099

Publication Date

August 2013

Volume

29

Issue

8

Start / End Page

943 / 949

Location

Scotland

Related Subject Headings

  • Surveys and Questionnaires
  • Singapore
  • Pregnancy
  • Practice Patterns, Nurses'
  • Nursing
  • Nurse Midwives
  • Midwifery
  • Middle Aged
  • Humans
  • Focus Groups
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wu, L. C., Lie, D., Malhotra, R., Allen, J. C., Tay, J. S. L., Tan, T. C., & Ostbye, T. (2013). What factors influence midwives' decision to perform or avoid episiotomies? A focus group study. Midwifery, 29(8), 943–949. https://doi.org/10.1016/j.midw.2012.11.017
Wu, Lin Chieh, Désirée Lie, Rahul Malhotra, John C. Allen, Julie S. L. Tay, Thiam Chye Tan, and Truls Ostbye. “What factors influence midwives' decision to perform or avoid episiotomies? A focus group study.Midwifery 29, no. 8 (August 2013): 943–49. https://doi.org/10.1016/j.midw.2012.11.017.
Wu LC, Lie D, Malhotra R, Allen JC, Tay JSL, Tan TC, et al. What factors influence midwives' decision to perform or avoid episiotomies? A focus group study. Midwifery. 2013 Aug;29(8):943–9.
Wu, Lin Chieh, et al. “What factors influence midwives' decision to perform or avoid episiotomies? A focus group study.Midwifery, vol. 29, no. 8, Aug. 2013, pp. 943–49. Pubmed, doi:10.1016/j.midw.2012.11.017.
Wu LC, Lie D, Malhotra R, Allen JC, Tay JSL, Tan TC, Ostbye T. What factors influence midwives' decision to perform or avoid episiotomies? A focus group study. Midwifery. 2013 Aug;29(8):943–949.
Journal cover image

Published In

Midwifery

DOI

EISSN

1532-3099

Publication Date

August 2013

Volume

29

Issue

8

Start / End Page

943 / 949

Location

Scotland

Related Subject Headings

  • Surveys and Questionnaires
  • Singapore
  • Pregnancy
  • Practice Patterns, Nurses'
  • Nursing
  • Nurse Midwives
  • Midwifery
  • Middle Aged
  • Humans
  • Focus Groups