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Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery.

Publication ,  Journal Article
Wu, LC; Malhotra, R; Allen, JC; Lie, D; Tan, TC; Østbye, T
Published in: Arch Gynecol Obstet
December 2013

PURPOSE: In Singapore, a developed Asian nation, a relatively high proportion of women undergo episiotomy. We assess risk factors and midwife-reported reasons for episiotomy among women undergoing normal vaginal deliveries (NVDs) conducted by midwives and ascertain the association between episiotomy and degree of perineal tear. METHODS: Participants included 77 midwives from a high-volume delivery unit in Singapore. The study had three sequential phases: (1) medical record review of women undergoing NVDs conducted by midwives over a 1-month period to document the proportion with episiotomy; (2) focus group discussions with midwives to form a checklist of reasons for episiotomy; (3) checklist-based documentation of midwife-reported reasons for episiotomy and data collection on maternal, neonatal, practice and midwife factors, and degree of perineal tear among women undergoing NVDs conducted by midwives over a 2-month period. Risk factors for episiotomy were assessed through logistic regression. RESULTS: Primiparity, advanced maternal age, Indian ethnicity, higher birth weight and older midwife age were associated with episiotomy. The most common midwife-reported reason for episiotomy among primiparous women was primiparity (55.1%), and among multiparous women was fetal distress (20.0%) and poor maternal effort (20.0%). All women with episiotomy sustained at least a second-degree perineal tear versus 27.1% among women without episiotomy. CONCLUSION: Most midwife-reported reasons for episiotomy were not congruent with international practice guidelines. Women without episiotomy have lesser tears than those with episiotomy. Practice protocols and educational programs are needed to change episiotomy practice.

Duke Scholars

Published In

Arch Gynecol Obstet

DOI

EISSN

1432-0711

Publication Date

December 2013

Volume

288

Issue

6

Start / End Page

1249 / 1256

Location

Germany

Related Subject Headings

  • Singapore
  • Risk Factors
  • Retrospective Studies
  • Prevalence
  • Pregnancy Outcome
  • Pregnancy
  • Practice Patterns, Nurses'
  • Perineum
  • Parity
  • Obstetrics & Reproductive Medicine
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wu, L. C., Malhotra, R., Allen, J. C., Lie, D., Tan, T. C., & Østbye, T. (2013). Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet, 288(6), 1249–1256. https://doi.org/10.1007/s00404-013-2897-6
Wu, Lin Chieh, Rahul Malhotra, John Carson Allen, Desiree Lie, Thiam Chye Tan, and Truls Østbye. “Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery.Arch Gynecol Obstet 288, no. 6 (December 2013): 1249–56. https://doi.org/10.1007/s00404-013-2897-6.
Wu LC, Malhotra R, Allen JC, Lie D, Tan TC, Østbye T. Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet. 2013 Dec;288(6):1249–56.
Wu, Lin Chieh, et al. “Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery.Arch Gynecol Obstet, vol. 288, no. 6, Dec. 2013, pp. 1249–56. Pubmed, doi:10.1007/s00404-013-2897-6.
Wu LC, Malhotra R, Allen JC, Lie D, Tan TC, Østbye T. Risk factors and midwife-reported reasons for episiotomy in women undergoing normal vaginal delivery. Arch Gynecol Obstet. 2013 Dec;288(6):1249–1256.
Journal cover image

Published In

Arch Gynecol Obstet

DOI

EISSN

1432-0711

Publication Date

December 2013

Volume

288

Issue

6

Start / End Page

1249 / 1256

Location

Germany

Related Subject Headings

  • Singapore
  • Risk Factors
  • Retrospective Studies
  • Prevalence
  • Pregnancy Outcome
  • Pregnancy
  • Practice Patterns, Nurses'
  • Perineum
  • Parity
  • Obstetrics & Reproductive Medicine