Selective versus routine episiotomy for Chinese primiparous women : Hong Kong midwives' concerns

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Selective versus routine episiotomy for Chinese primiparous women : Hong Kong midwives' concerns


Author: Iu, Po-lan
Title: Selective versus routine episiotomy for Chinese primiparous women : Hong Kong midwives' concerns
Degree: M.Sc.
Year: 2010
Subject: Hong Kong Polytechnic University -- Dissertations
Midwives -- Practice -- China -- Hong Kong
Delivery (Obstetrics)
Department: School of Nursing
Pages: vii, 134 p. : ill. ; 30 cm.
Abstract: Episiotomy has been used worldwide for many years. The use of episiotomy is varied in many different areas in the world and it is a controversial issue in modern maternity care. Many researchers advise restrictive use of it due to its potential risks on laboring women because of increasing blood loss, pain, infection and dyspareunia. The current episiotomy practice is in question even though many midwives acknowledge its inherited benefits on accelerating the delivery process and believe that the procedure could improve the maternal and fetal outcomes. The indications for an episiotomy during vaginal delivery largely rely on the immediate assessment and clinical judgment of the healthcare professionals. Midwives are the main care providers for majority of women during the process of normal vaginal delivery. The midwives' clinical judgment and the considerations to the individual circumstances during delivery will directly affect the types of service and quality of maternity care. Episiotomy is fostered and performed commonly for primiparous women during vaginal delivery in Hong Kong and very few local studies discussed the use and functions of episiotomy among the Chinese women. Regarding the client-centered care, the midwives should notice that the types of care or interventions should be tailor-made to meet the health needs. Meanwhile the advantages of episiotomy to women are not verified, a routine episiotomy practice becomes a controversy. The maternal outcomes of routine episiotomy among primiparous women have challenged the belief and explanations of the midwives. In order to understand the purposes and motives of the practitioners who perform and promote routine episiotomy, the aim of this study is to explore the views and concerns of the local midwives on choosing either routine or selective episiotomy for the primiparous women in spontaneous vaginal delivery.
This study is a descriptive qualitative research design. Purposive sampling method was used to obtain data from the informants through a semi-structured interview. Prior to the main study, two midwives were invited for the pilot study to assess the feasibility and appropriateness of the interview questions and interviewing techniques. In the main study, ten registered midwives of an obstetric department from a local hospital were interviewed. The interview contents were analyzed with the qualitative content analysis method. The research findings showed that episiotomy was commonly performed for primiparous women, but comparatively less for multiparous women. The findings identified some factors that might affect the midwives. decision on using episiotomy. These factors are classified into four categories: the midwifery practitioner, the clinical practice, organization and recipients. Most informants, having been trained in the basic midwifery training, maintain that Chinese primiparous women require episiotomy owing to the rigid and tight perineum. Routine episiotomy is commonly performed when the midwife lacks clinical practice experience, or when they perceive there is a heavy workload and pressure from their peers at workplace. Most of the informants agreed that they are worried about the occurrence of severe tear if episiotomy is not performed in due course. The decision and preference of senior midwives on the use of episiotomy hinders the junior midwives' autonomy and decision-making on episiotomy use. The role of parity (primipara), the characteristics of perineum (tight and short perineum), and the risks of perineal tear(s) among the women are the common factors for determining the use of episiotomy. On the other hand, the size and level of distress of the fetus are the general causes to consider an episiotomy. Besides, most informants are willing to involve the laboring women's preference in the decision-making of episiotomy use. The midwives expect to obtain the consent (both written and verbal agreement) if episiotomy is required. As we believe that midwives are advocates of the clients in midwifery care, it is a necessary to explore how midwifery practitioners are empowered to exercise their decision-making and make clinical judgment with the supports of relevant and verified evidence relating to the client's needs. The role of policy and guidelines for midwifery practice and early involvement of the women in the decision-making of childbirth interventions are imperative.

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