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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women and BirthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Episiotomy rates around the world: an update.Birth. 2005; 32: 219-223
- Does episiotomy prevent perineal trauma and pelvic floor relaxation?.Online J Curr Clin Trials. 1992; 106: 375-377
- Episiotomy and severe perineal trauma: of science and fiction.Can Med Assoc J. 1997; 156: 811
- Outcomes of routine episiotomy.J Am Med Assoc. 2005; 293: 2141-2148
- Episiotomy for vaginal birth.Cochrane Database Syst Rev. 2009; CD000081https://doi.org/10.1002/14651858.CD000081.pub2
- Benefits and risks of episiotomy: an interpretative review of the English language literature, 1860–1980.Obstet Gynecol Surv. 1983; 38: 322-338
- Using evidence to reduce the rate of episiotomy in a Dubai hospital.Evid-Based Midwifery. 2009; 7: 60
- Methods and materials used in perineal repair.2004
- Perinatal outcomes of women intending to give birth in birth centers in Australia.Birth. 2010; 37: 28-36
- Managing complications in pregnancy and childbirth. Geneva.2003: 71-75
- What makes episiotomy rates change?: a systematic review of the literature.Int J Childbirth. 2012; 2: 29-39
- Evidence-based obstetric care in South Africa-influencing practice through the ‘Better Births Initiative’.S Afr Med J. 2004; 94: 117-120
- Changed pattern in the use of episiotomy in Sweden.Int J Obstet Gynecol. 1999; 106: 95-101
- The quality improvement process.McGraw Hill, New York, NY1999
- Evaluating the experience of Jordanian women with maternity care services.Health Care Women Int. 2013; 34: 499-512
- Qualitative research in health care.Wiley.com, 2008
- Teaching thematic analysis: overcoming challenges and developing strategies for effective learning.Psychologist. 2013; 26: 120-123
- The PARIHS framework – a framework for guiding the implementation of evidence-based practice.J Nurs Care Qual. 2004; 19: 297-304
- Hospital practices in maternity wards in Lebanon.Health Policy Plan. 2000; 15: 270-278
- Evaluation of evidence-based episiotomy practice by midwives.Afr J Midwifery Women's Health. 2010; 4: 80-87
- Evidence-based reproductive health care in Cameroon: population-based study of awareness, use and barriers.Bull World Health Organ. 2005; 83: 895-903
- Evidence-based medicine among hospital doctors in Jordan: awareness, attitude and practice.J Eval Clin Pract. 2009; 15: 1137-1141
- Models and frameworks for implementing evidence-based practice: linking evidence to action.Wiley Blackwell, 2011
- Organizational silence: a barrier to change and development in a pluralistic world.Acad Manag Rev. 2000; 25: 706-725
- Survey of knowledge and perception on the access to evidence-based practice and clinical practice change among maternal and infant health practitioners in South East Asia.BMC Pregnancy Childbirth. 2008; 8: 34
- Authoritative knowledge and its construction.in: Davis-Floyd R. Sargent C.F. Childbirth and authoritative knowledge. Cross-cultural perspectives. University of California Press, Berkeley1997: 55-79
- The technocratic model of birth.in: Tower Hollis S. Pershing L. Jane Y.M. Feminist theory in the study of folklore. University of Illinois Press, Illinois1993: 297-326
- In labor: women and power in the birthplace.W W Norton & Co, New York/London1982
- Managing the monstrous feminine: regulating the reproductive body.Routledge, London2006
- The woman in the body: a cultural analysis of reproduction.Beacon Press, Boston2001
- Male appropriation and medicalization of childbirth: an historical analysis.J Adv Nurs. 2001; 33: 334-342
- What factors influence midwives’ decision to perform or avoid episiotomies? A focus group study.Midwifery. 2013; 29
- Third world women and the politics of feminism.Indiana University Press, 1991
- Quality Assurance and Spiritual Care.J Empir Theol. 2011; 24: 80-121
- Leadership in organizations.National College for School Leadership, 2003
- Transformational leadership.2nd ed. Lawrence Erlbaum Associates, New Jersey2012
- A comparison of labour and birth outcomes in Jordan with WHO guidelines: a descriptive study using a new birth record.Midwifery. 2009; 25: e11-e18
- Maternal positions and mobility during first stage labour.Cochrane Database Syst Rev. 2013; CD003934https://doi.org/10.1002/14651858.CD003934.pub
- The experience of labour: using ethnography to explore the irresistible nature of the biomedical metaphor during labour.Midwifery. 1997; 13: 78-84
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.