Influence of training in the use and generation of evidence on episiotomy practice and perineal trauma

OBJECTIVE: To examine episiotomy practices before and after a multi-component intervention designed to support the use and generation of research evidence in maternal and neonatal health care. METHODS: Set in 9 centers across 4 Southeast Asian countries, a retrospective survey was performed for 12 recommended pregnancy/childbirth practices and 13 outcomes of women in each center before and after intervention. Qualitative interviews were conducted to assess staff awareness and experience in evidence-based practice. RESULTS: There were significant decreases in the rate of episiotomy, from 64.1% to 60.1% (risk difference [RD] –4.0; 95% confidence interval [CI], –5.8 to –2.2) for all women and from 92.2% to 80.7% (RD –11.5; 95% CI, –13.4 to –9.6) for nulliparous women. Severe trauma decreased from 3.9% to 1.9% (RD –2.0; 95% CI, –2.7 to –1.4) for all women and from 6.7% to 3.0% (RD –3.7; 95% CI, –4.9 to –2.5) for nulliparous women. The frequency of intact perineum increased from 12.4% to 15.6% (RD 3.2; 95% CI, 1.9–4.6) for all women and from 1.7% to 8.0% (RD 6.3; 95% CI, 5.0–7.5) for nulliparous women. CONCLUSION: An intervention based on understanding and using the best available evidence can result in significant improvements in care and health outcomes.