A qualitative study exploring healthcare professionals' perceptions regarding selective versus routine episiotomy

This study aimed to explore healthcare professionals' perceptions of selective versus routine episiotomy practices, identify factors influencing their decision- making, and gather challenges and recommendations for implementing selective episiotomy.

A qualitative descriptive exploratory design was used, employing purposive sampling to enrol 15 participants (five obstetricians, five nurses, five midwives), each with at least one year of clinical experience in labour and obstetric units. Data collection included in-depth interviews conducted in-person or via Zoom, lasting 30-45 minutes, and audio-recorded. Thematic analysis was conducted to extract key themes and sub-themes.

Participants were unaware of international episiotomy guidelines and relied on personal clinical judgement for decision-making. The primary reason for performing an episiotomy was to prevent severe perineal tears, with minimal involvement of mothers in the process. Despite preferring selective episiotomy, routine episiotomy was commonly practiced due to barriers like inadequate training, institutional norms, and outdated practices. This discrepancy highlights the need for improvement in practice. The study recommends better training, updated clinical guidelines, and enhanced patient counselling to promote evidence-based episiotomy practice.

The study highlights a gap between healthcare providers' preferences for selective episiotomy and their routine practices, driven by institutional norms and inadequate training. Enhancing training, incorporating evidence-based episiotomy practices into curricula, updating guidelines, and improving patient involvement are essential for better clinical outcomes.