Crowe, Grace, Miles, Maureen, and Nagle, Cate (2018) Exploring midwives' practice and experience of episiotomy. Women and Birth, 31 (S1). P24. S49-S49.

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Abstract

Aim: This study explored Australian midwives' experience and practice of performing an episiotomy.

Background: Evidence underpins the recommended angle and length of episiotomy to avoid morbidity for the woman, yet there is limited research regarding midwives' episiotomy knowledge, skill and attitudes.

Methods: A cross-sectional anonymous survey of Australian midwives with current birthing experience was employed. The survey contained items modified from validated instruments with Likert scales, a diagram, categorical responses and open ended responses. Data was analysed using descriptive statistics and thematic analysis.

Results: A total of 360 surveys responses were analysed. Approximately half (46%) midwives were in senior clinical positions. Experience varied considerably, with approximately half of the midwives (55.6%) having undertaken <4 episiotomies independently and 20% 'very confident' in the procedure. Only 28% midwives identified the episiotomy length correctly while 73% midwives identified the angle correctly. Two thirds of participants (n=236) identified the correct angle on the pictorial representation. Overall, only 15% of midwives identified the three characteristics of a correctly performed episiotomy. The three most common clinical reasons for performing an episiotomy were fetal distress, perineal 'buttonhole' and previous severe perineal trauma. Analysis of attitudes revealed themes such as lack of confidence and experience, fear, and limited evidence supporting episiotomy explaining midwives' use/non-use of episiotomy. There was significant variation in health service requirements to establish a midwife's competence to perform episiotomy. Most midwives (75%, n=270) wanted further education regarding episiotomy, with face-to-face workshops as the preferred format for education.

Conclusion: Knowledge and practice gaps demonstrated the need for continuing professional development to translate evidence to practice and promote optimal outcomes for women. Many midwives are inexperienced with the procedure and simulation in workshops may assist midwives feel more confident to perform an episiotomy when is clinically indicated.

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