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The barriers and facilitators to evidence-based episiotomy practice in Jordan

This paper examines the barriers to evidence-based episiotomy practice in Jordan and identifies strategies that may be effective in introducing evidence-based practice. Episiotomy is routinely undertaken during birth in many parts of the world, including in the Middle East with little scientific evi...

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Published in:Women and birth : journal of the Australian College of Midwives 2016-08, Vol.29 (4), p.321-329
Main Authors: Hussein, Suha Abed Almajeed Abdallah, Dahlen, Hannah G., Duff, Margaret, Schmied, Virginia
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cited_by cdi_FETCH-LOGICAL-c425t-438143cce2d7944e2ded64e21cedf2f2c7b3dda983f1b524d2aa0db7b8df47843
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container_title Women and birth : journal of the Australian College of Midwives
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creator Hussein, Suha Abed Almajeed Abdallah
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description This paper examines the barriers to evidence-based episiotomy practice in Jordan and identifies strategies that may be effective in introducing evidence-based practice. 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. 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. 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’. 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.
doi_str_mv 10.1016/j.wombi.2015.12.006
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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. 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. 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’. 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’. 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subjects Attitude of Health Personnel
Attitudes
Delivery, Obstetric - statistics & numerical data
Episiotomy
Episiotomy - adverse effects
Episiotomy - statistics & numerical data
Evidence-Based Practice
Female
Humans
Jordan - epidemiology
Midwife
Midwifery - methods
Nursing
Practice Patterns, Nurses' - statistics & numerical data
Pregnancy
Retrospective Studies
title The barriers and facilitators to evidence-based episiotomy practice in Jordan
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