Date of Award

11-4-2024

Degree Type

Thesis

Degree Name

Master of Science in Nursing (MScN)

First Advisor

Dr. Salma Rattani

Second Advisor

Dr. Nadeem Zuberi

Third Advisor

Ms. Rahila Meghani

Department

School of Nursing and Midwifery, Pakistan

Abstract

Introduction: Normal vaginal delivery is considered a favorite mode of delivery. However perineal trauma due to episiotomy is a significant concern in obstetric care nowadays. Although routine episiotomy practice is discouraged because there is no evidence present regarding its benefits but still the rate of episiotomy is very high especially in lower-middle-income countries as compared to the recommendation by the World Health Organization (WHO) which is 10% of all normal vaginal deliveries (World Health Organization, 2018).
Objectives: • To understand healthcare professionals' perceptions regarding selective versus routine episiotomy practices. • To investigate the factors influencing their decision-making process regarding episiotomy. • To identify the challenges and gather recommendations for implementing selective episiotomy.
Method: A qualitative descriptive exploratory study was conducted using a purposive sampling method, 15 participants; five obstetricians, five nurses, and five midwives each with at least one year of clinical experience in the labour room and obstetric unit were enrolled in this research. Data collection was done through in-depth interviews, either in-person or via an online conferencing platform (Zoom), lasting for 30 to 45 minutes. These interviews were audio recorded. Through thematic analysis, key themes and sub-themes were extracted.
Results: Most participants lacked a clear understanding of the difference between selective and routine episiotomy. The most commonly reported reason for performing episiotomies was to prevent third and fourth-degree tears. Compared to obstetricians, nurses and midwives favoured selective episiotomy, believing it should be performed only when necessary for a woman. All the participants described selective episiotomy practice was challenging to be implemented due to factors such as poor tissue integrity, the poor nutritional status of mothers, sedentary lifestyles, lack of institutional policy, and limited support from senior obstetricians and management.
Conclusions: The participants in this research were not aware of international practices and guidelines for episiotomy. As they are the care providers, they need to be aware of these guidelines. Accordingly, their practices are to be in line with these guidelines.

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Last Page

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