Differences In Episiotomy Technique Between Midwives And Doctors

Abstract
Objectives
To examine the practice of making an episiotomy and to determine any differences in practice between professional groups.

Design
A prospective survey.

Setting
A large tertiary referral obstetric hospital and the obstetric department of a district general hospital.

Population
All staff routinely involved in the care of women in labour.

Methods
A novel validated pictorial questionnaire was designed, validated and distributed to the study population. Differences in outcome measures were compared by profession and by seniority.

Main outcome measures
Measurements taken from the questionnaire: the length of episiotomy drawn; the distance from the sagittal plane at which the episiotomy was begun; and the angle of the episiotomy from the sagittal plane.

Results
Fifty doctors and 78 midwives completed the forms. Median distance of the episiotomy from the midline was 0 mm (−2 to 11). Episiotomies drawn by doctors were significantly longer and more angled than those drawn by midwives (P = 0.002 and P= 0.001). Sixteen percent of doctors and 1% of midwives drew an episiotomy longer than 20 mm (difference 15%, 95% CI 6 to 24). Twenty-three percent of midwives and 2% of doctors drew an episiotomy angled 30° or less (difference 21%, 95% CI 9 to 34).

Conclusions
This study has demonstrated differences in the reporting of episiotomy practice by doctors and midwives. Theoretically, the differences demonstrated could predispose to a greater risk of anal sphincter injuries. These data need to be confirmed by observational studies of actual practice and by studies to investigate the mechanics of sphincter injury during childbirth.

Source