Abstract
Aim
This paper examines the barriers to evidence-based episiotomy practice in Jordan and
identifies strategies that may be effective in introducing evidence-based practice.
Background
Episiotomy is routinely undertaken during birth in many parts of the world, including
in the Middle East with little scientific evidence of benefit. There is a paucity
of research examining the underlying drivers for episiotomy rates, and why they are
higher in some countries.
Method
This study, conducted in Jordan, used a quality improvement approach and comprised
three phases. In phase one, a retrospective file review of 300 births was conducted.
In phase two, 15 face-to-face interviews were conducted with 10 midwives and five
key stakeholders (managers and doctors). A feedback and discussion session using the
audit and review model was conducted in phase three with 23 health professionals to
identify strategies to reduce the episiotomy rate.
Results
The episiotomy rate was 41.4% overall (91% of primiparous women and 24% of multiparous
women). Six major themes emerged from the thematic analysis of data: ‘Policy: written
but invisible and unwritten and assumed’; ‘the safest way’; ‘doctors set the rules’;
‘midwives swimming with the tide; ‘uncooperative and uninformed women’ and ‘the way
forward’.
Conclusions
Non-evidence based episiotomy practices are widely used during birth in this Jordanian
hospital and numerous barriers to change exist. Medical professionals dictate childbirth
practice and midwives fear recrimination if they go against the ‘unwritten policy’.
Strategies to change practice include development of evidence-based information for
women, education of midwives and doctors, and policy review.
Keywords
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Article info
Publication history
Published online: January 30, 2016
Accepted:
December 29,
2015
Received in revised form:
November 22,
2015
Received:
August 23,
2015
Publication stage
In Press Corrected ProofIdentification
Copyright
Crown Copyright © 2016 Published by Elsevier Ltd on behalf of Australian College of Midwives. All rights reserved.
