Abstract
Background
One of four key points in the Obstetric Anal Sphincter Injury Care Bundle, first piloted
in the UK in 2016, was the directive to perform episiotomy when clinically indicated.
Midwives are the primary health care professional for straightforward births in the
UK and there is very little published literature that relates to their practice in
this area.
Aim
The aim of the study was to explore experienced midwives’ decision-making processes
in their assessments for episiotomy during birth.
Methods
43 midwives self-identifying as confident in performing episiotomy were sampled across
8 NHS Trusts in England and Wales. Data collection was via online focus groups and
1:1 interviews. Primary thematic analysis was undertaken by the research team. Preliminary
themes were used to structure a co-production analysis workshop where eight experienced
midwives undertook a secondary analysis of the data resulting in four overall themes.
Findings
Four themes were identified, ‘Optimising Perineal Function’, ‘Red Flags to Stimulate
Decision-Making’, ‘The Midwives’ Episiotomy’ and ‘Infiltration as a Catalyst for Birth’.
Discussion
Midwives use a number of visual, auditory and touch cues to inform their assessments
for episiotomy during birth.
Conclusion
This study provides valuable insight into the cues that guide experienced midwives’
decision-making in relation to episiotomy and contributes evidence related to performing
episiotomy when clinically indicated in spontaneous vaginal birth.
Keywords
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Article info
Publication history
Published online: August 05, 2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Published by Elsevier Ltd on behalf of Australian College of Midwives.
