![]() The written data were categorized and coded in a spreadsheet for each profession. At the time of the study respondents did not know the researchers' opinion on the subject. Specific questions were asked about the influence of vacuum extraction, maternal fatigue (locally called “poor maternal effort”) nulliparous versus parous and the healing of the perineum. Focus in the questionnaire was on the following subjects: the general opinion about episiotomies, indications, contraindications, education, experience, the influence of HIV, and the fear of transmission from mother to child. The respondents all speak and write English fluently. The questionnaires were written and completed in English. All agreed and completed the questionnaire. All were asked for consent and explained that the results would be used anonymously. The study population consists of all members of staff who attend deliveries: eight midwives, seven nurses, two clinical officers, and three unqualified staff members. Second, a written questionnaire was compiled with open and closed in-depth questions ( Supplemental Appendix 1). Outcomes were treated confidentially and were used to define questions for the survey. The interview results were captured in written notes. Therefore, we expected people to freely express their feelings and opinions. During this period mutual trust and respect were built to overcome hierarchical issues and cultural differences. #I GIVE ALL MY PATIENTS EPISIOTOMIES PROFESSIONAL#At the time of the interview, the key informants and the interviewer (the supervising medical officer) had a good professional working relation for 1 year. The key informants all attend deliveries frequently. They were also chosen by sex: two females and one male. These were chosen from three different professions: one midwife, one nurse, and one unqualified member of staff. These methods are interviews with key persons, a survey using written questionnaires, and a group discussion.įirst, an interview protocol with loosely structured questions was developed and exploratory interviews were done with three key informants. Combining different outcomes of different research methods will yield more reliable results. To increase the internal validity of this qualitative research by means of methodological triangulation, three complementary methods have been chosen. More insight into staff attitude regarding episiotomies might open discussion on the matter, both within the hospital and elsewhere. We focus on the possible influence of the fear of transmitting HIV from mother to child. To this end, we study how they balance indications and contraindications and whether they are confident in performing the procedure. The aim of this research is to develop a deeper understanding in the clinical assessments made by staff in Lumezi Mission Hospital. 7, 8, 10 The need for an episiotomy in practice is thus largely based on “clinical assessment” or “clinical opinion.” As a result, many different opinions are found in the literature, between practitioners, between countries, and over time. ![]() Some of these indications and/or contraindications for episiotomies are subjective. 4, 9 Contraindications for episiotomy are a lack of descent of the fetus, uncertainty about the possibility of a vaginal delivery, and a fast, uncomplicated delivery. 7, 8 Most common indications are fetal condition/fetal distress, prematurity, macrosomia, suspected shoulder dystocia, instrumental delivery, primiparity, short perineum (< 3 cm), tight perineum, previous third degree tear, maternal fatigue, and prolonged labor. Worldwide, the use of episiotomies is decreasing. The authors recommend a restrictive use of episiotomies. 4 – 6 A Cochrane review of eight studies shows there are no significant differences for mother and neonate between a restrictive and a liberal application of episiotomies. This observation is remarkable, as most of the literature concerns the “over-use” of episiotomies. §Maternal mortality rate: 5 deaths/1068 deliveries = 0.47%. ![]()
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