Using evidence to reduce the rate of episiotomy in a Dubai hospital
School of Nursing and Midwifery, East Africa
Background: A retrospective survey of birth statistics in Al Wasl Hospital in Dubai in 2006 found that episiotomy was routinely performed on a wide range of women including primigravida, women who had instrumental deliveries, pregnancies with abnormal presentation, fetal distress, large babies, and multigravida women with a perceived rigid perineum. The rate of episiotomy for all women was 64%. Despite this high rate, five women (0.2%) also suffered third and fourth degree tears.
Aim: This study was undertaken to assess the existing practice of performing episiotomy and to develop multidisciplinary evidence-based guidelines, which could be introduced to change practice around the routine use of episiotomy.
Methods: A review of the literature was undertaken, which questioned the use of routine episiotomy. The authors set out to change practice by utilising a systematic quality improvement model called FOCUS-PDCA, a nine-step process guide to improving quality. By using this model and engaging with medical and midwifery staff, guidelines were produced.
Findings: As a result of cooperation and compliance from all staff, the rate of episiotomy fell from 64% in 2006 to less than 20% in 2008, with no increase in the incidence of third- and fourth-degree tears.
Evidence Based Midwifery
Benjamin, E. E.,
(2009). Using evidence to reduce the rate of episiotomy in a Dubai hospital. Evidence Based Midwifery, 7(2), 60-63.
Available at: http://ecommons.aku.edu/eastafrica_fhs_sonam/108