Perception regarding restricted episiotomy: A qualitative study

Sindhumol Pk, A. Elif Posos Devrani, Lissamma Pv
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Abstract

Background/Aim: Episiotomy is a planned surgical incision in the perineum and posterior vaginal wall in the second stage of labour to enlarge vaginal opening during delivery. It is one of the most commonly preferred obstetric operation during delivery since 1920 and practised routinely in most of the developing countries till today. Restricted practice refers to episiotomy reserved for situations where there is clear indication to perform the procedure. World Health Organisation (2018) recommends restricted practice of episiotomy. Voluminous literature highlights extensive disagreement about the necessity and benefits of the procedure. Even though the pendulum has swung back the practice of liberal episiotomy is still higher than the expected rate. Role of decision ends up in the midwives/ obstetrician’s hands who conduct the delivery. Limited researchers have examined the motive behind practicing liberal episiotomy. In this context a qualitative study was conducted to address the issues from midwives/obstetrician’s own perception regarding restricted practice of episiotomy. Materials and methods: This is a phenomenological approach qualitative study using the thematic analysis. The participants included 15 midwives and 8 obstetricians with minimum experience of one year selected by purposive sampling and attended semi structured interview. Results: The themes emerged after data analysis are Negative impact on self and maternal morbidity and Inadequate readiness. Conclusion: The subjective opinion of midwives/obstetricians could identify reasons behind the reluctance to give up the age old practice and threw light in to the gap that exists in practice and scientific evidence. Conscious effort may be taken by the midwives /obstetricians to adopt the best evidence based protocol and deliver quality care.
关于限制性外阴切开术的认知:一项定性研究
背景/目的:会阴切开术是在分娩第二阶段在会阴和阴道后壁处进行的有计划的手术切口,以扩大阴道开口。自1920年以来,它是分娩期间最常用的产科手术之一,直到今天,在大多数发展中国家都是常规手术。限制性手术指的是在有明确指征的情况下进行会阴切开术。世界卫生组织(2018年)建议限制外阴切开术。大量文献强调了关于该手术的必要性和益处的广泛分歧。即使钟摆已经摆回来,实践自由外阴切开术仍然高于预期的比率。决定的角色最终落在接生的助产士/产科医生手中。有限的研究人员调查了自由外阴切开术背后的动机。在此背景下,进行了一项定性研究,以解决助产士/产科医生自己对外阴切开术限制实践的看法。材料与方法:本研究采用主题分析的现象学方法进行定性研究。采用有目的抽样的方法,选取15名助产士和8名经验至少1年的产科医生,进行半结构化访谈。结果:经数据分析得出的主题是对自我和孕产妇发病率的负面影响和准备不足。结论:助产士/产科医生的主观意见可以找出不愿放弃老做法背后的原因,并为实践中存在的差距和科学证据提供线索。助产士/产科医生可能会有意识地采取措施,采用最佳的循证方案,提供高质量的护理。
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