Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice....

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Bibliographic Details
Published in:BMC pregnancy and childbirth 2021-08, Vol.21 (1), p.1-549, Article 549
Main Authors: Garcia-Cerde, Rodrigo, Torres-Pereda, Pilar, Olvera-Garcia, Marisela, Hulme, Jennifer
Format: Article
Language:English
Subjects:
Childbirth & labor
Confidentiality
Emergencies
Episiotomy
Evidence-based medicine
Gynecology
Hospitals
Human rights
Intervention
Maternal child nursing
Medical research
Nurses
Obstetrics
Patients rights
Perceptions
Physicians
Qualitative research
Respectful maternity care
Training
Vagina
Womens health
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Summary:Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program. Methods This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.
ISSN:1471-2393
1471-2393
DOI:10.1186/s12884-021-04022-x