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Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study

OBJECTIVES: Insight into perspectives and values of care providers on episiotomy can be a first step towards reducing variation in its use. We aimed to gain insight into these perspectives and values. SETTING: Maternity care in the Netherlands. PARTICIPANTS: Midwives, obstetricians and obstetric reg...

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Autores principales: Seijmonsbergen-Schermers, Anna, Thompson, Suzanne, Feijen-de Jong, Esther, Smit, Marrit, Prins, Marianne, van den Akker, Thomas, de Jonge, Ank
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812089/
https://www.ncbi.nlm.nih.gov/pubmed/33441351
http://dx.doi.org/10.1136/bmjopen-2020-037536
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author Seijmonsbergen-Schermers, Anna
Thompson, Suzanne
Feijen-de Jong, Esther
Smit, Marrit
Prins, Marianne
van den Akker, Thomas
de Jonge, Ank
author_facet Seijmonsbergen-Schermers, Anna
Thompson, Suzanne
Feijen-de Jong, Esther
Smit, Marrit
Prins, Marianne
van den Akker, Thomas
de Jonge, Ank
author_sort Seijmonsbergen-Schermers, Anna
collection PubMed
description OBJECTIVES: Insight into perspectives and values of care providers on episiotomy can be a first step towards reducing variation in its use. We aimed to gain insight into these perspectives and values. SETTING: Maternity care in the Netherlands. PARTICIPANTS: Midwives, obstetricians and obstetric registrars working in primary, secondary or tertiary care, purposively sampled, based on their perceived episiotomy rate and/or region of work. PRIMARY AND SECONDARY OUTCOME MEASURES: Perspectives and values of care providers which were explored using semistructured in-depth interviews. RESULTS: The following four themes were identified, using the evidence-based practice-model of Satterfield et al as a framework: ‘Care providers’ vision on childbirth’, ‘Discrepancy between restrictive perspective and daily practice’, ‘Clinical expertise versus literature-based practice’ and ‘Involvement of women in the decision’. Perspectives, values and practices regarding episiotomy were strongly influenced by care providers’ underlying visions on childbirth. Although care providers often emphasised the importance of restrictive episiotomy policy, a discrepancy was found between this vision and the large number of varying indications for episiotomy. Although on one hand care providers cited evidence to support their practice, on the other hand, many based their decision-making to a larger extent on clinical experience. Although most care providers considered women’s autonomy to be important, at the moment of deciding on episiotomy, the involvement of women in the decision was perceived as minimal, and real informed consent generally did not take place, neither during labour, nor prenatally. Many care providers belittled episiotomy in their language. CONCLUSIONS: Care providers’ underlying vision on episiotomy and childbirth was an important contributor to the large variations in episiotomy usage. Their clinical expertise was a more important component in decision-making on episiotomy than the literature. Women were minimally involved in the decision for performing episiotomy. More research is required to achieve consensus on indications for episiotomy.
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spelling pubmed-78120892021-01-25 Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study Seijmonsbergen-Schermers, Anna Thompson, Suzanne Feijen-de Jong, Esther Smit, Marrit Prins, Marianne van den Akker, Thomas de Jonge, Ank BMJ Open Obstetrics and Gynaecology OBJECTIVES: Insight into perspectives and values of care providers on episiotomy can be a first step towards reducing variation in its use. We aimed to gain insight into these perspectives and values. SETTING: Maternity care in the Netherlands. PARTICIPANTS: Midwives, obstetricians and obstetric registrars working in primary, secondary or tertiary care, purposively sampled, based on their perceived episiotomy rate and/or region of work. PRIMARY AND SECONDARY OUTCOME MEASURES: Perspectives and values of care providers which were explored using semistructured in-depth interviews. RESULTS: The following four themes were identified, using the evidence-based practice-model of Satterfield et al as a framework: ‘Care providers’ vision on childbirth’, ‘Discrepancy between restrictive perspective and daily practice’, ‘Clinical expertise versus literature-based practice’ and ‘Involvement of women in the decision’. Perspectives, values and practices regarding episiotomy were strongly influenced by care providers’ underlying visions on childbirth. Although care providers often emphasised the importance of restrictive episiotomy policy, a discrepancy was found between this vision and the large number of varying indications for episiotomy. Although on one hand care providers cited evidence to support their practice, on the other hand, many based their decision-making to a larger extent on clinical experience. Although most care providers considered women’s autonomy to be important, at the moment of deciding on episiotomy, the involvement of women in the decision was perceived as minimal, and real informed consent generally did not take place, neither during labour, nor prenatally. Many care providers belittled episiotomy in their language. CONCLUSIONS: Care providers’ underlying vision on episiotomy and childbirth was an important contributor to the large variations in episiotomy usage. Their clinical expertise was a more important component in decision-making on episiotomy than the literature. Women were minimally involved in the decision for performing episiotomy. More research is required to achieve consensus on indications for episiotomy. BMJ Publishing Group 2021-01-13 /pmc/articles/PMC7812089/ /pubmed/33441351 http://dx.doi.org/10.1136/bmjopen-2020-037536 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Obstetrics and Gynaecology
Seijmonsbergen-Schermers, Anna
Thompson, Suzanne
Feijen-de Jong, Esther
Smit, Marrit
Prins, Marianne
van den Akker, Thomas
de Jonge, Ank
Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
title Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
title_full Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
title_fullStr Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
title_full_unstemmed Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
title_short Understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
title_sort understanding the perspectives and values of midwives, obstetricians and obstetric registrars regarding episiotomy: qualitative interview study
topic Obstetrics and Gynaecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812089/
https://www.ncbi.nlm.nih.gov/pubmed/33441351
http://dx.doi.org/10.1136/bmjopen-2020-037536
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