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Notice bibliographique (sans auteurs) :

What factors influence midwives’ decision to perform or avoid episiotomies? A focus group study - Midwifery - Vol. 29, 8 - ISBN: 0266-6138 - p.943-949

Auteur·e(s) :

Wu, Lin Chieh; Lie, Désirée; Malhotra, Rahul; Allen Jr, John C.; Tay, Julie S. L.; Tan, Thiam Chye; Østbye, Truls

Année de publication :

2013

URL(s) :

http://www.sciencedirect.com/science/article/pii/S…
https://doi.org/10.1016/j.midw.2012.11.017

Résumé (français)  :

Abstract (English)  :

Objective
to explore midwives’ reasons for performing or avoiding episiotomies and motivation to change episiotomy practice in a large tertiary maternity hospital.
Design
using purposive sampling, three focus groups were conducted to achieve theme saturation. Open-ended questions elicited personal reasons for performing or avoiding episiotomy, information sources, and opinions about past and future practice trends. Sessions were audiotaped, and transcripts independently examined by three researchers who coded for themes. An iterative process was used to achieve consensus. Grounded theory was used to interpret data and to derive a theoretical framework for understanding the reasoning that influences episiotomy practice.
Setting
a high volume delivery unit in Singapore.
Participants
20 of 79 licensed midwives, aged 28–70, who performed independent deliveries at the delivery unit.
Findings
participants recognised maternal, fetal and other factors affecting their own decision to perform episiotomies. Patient request, better healing, midwife’s reputation and job satisfaction were cited as main reasons to avoid episiotomy. Key sources informing practice were past training, delivery experience, anecdotal learning and lack of a protocol. There was no consensus on current trends in episiotomy practice. There was an absence of recognition of individual roles in reducing episiotomy rates. Clinicians were perceived as having both positive and negative influence.
Conclusions
midwives’ reasons for performing episiotomies were attributed to midwifery training, fear of doing harm and perceived clinician expectation, and were not consistent with current international practice guidelines. Reasons for avoiding episiotomies were associated with patient-centeredness and job satisfaction. Midwives agreed on the need to reduce episiotomy rates.
Implications for practice
with reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and experiences of midwives should also be incorporated into strategies to change episiotomy practice.

Sumário (português)  :

Resumen (español)  :

Remarques :

Argument (français) :

Avec pour objectif la réduction des taux d’épisiotomie, une combinaison d’éducation aux lignes directrices, de feedback, de coaching entre pairs et de soins en collaboration avec les médecins peut être nécessaire pour obtenir les résultats souhaités. Les points de vue et les expériences des sages-femmes devraient également être intégrés aux stratégies visant à modifier la pratique de l’épisiotomie.

Argument (English):

With reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and experiences of midwives should also be incorporated into strategies to change episiotomy practice.

Argumento (português):

Com a redução das taxas de episiotomia como meta, uma combinação de orientação educacional, feedback, orientação entre colegas e cuidados colaborativos com os médicos pode ser necessária para alcançar os resultados desejados. As visões e experiências das parteiras também devem ser incorporadas às estratégias para mudar a prática da episiotomia.

Argumento (español):

Mots-clés :

➡ violences gynécologiques et obstétricales violence obstétricale ; épisiotomie ; déontologie ; consentement éclairé

Auteur·e de cette fiche :

Import 02/08/2014 — 02 Aug 2014
➡ dernière modification : Bernard Bel — 01 Nov 2018