Duke-NUS Graduate Medical School, 8 College Road, Singapore.
Midwifery. 2013 Aug;29(8):943-9. doi: 10.1016/j.midw.2012.11.017. Epub 2013 Feb 28.
to explore midwives' reasons for performing or avoiding episiotomies and motivation to change episiotomy practice in a large tertiary maternity hospital.
using purposive sampling, three focus groups were conducted to achieve theme saturation. Open-ended questions elicited personal reasons for performing or avoiding episiotomy, information sources, and opinions about past and future practice trends. Sessions were audiotaped, and transcripts independently examined by three researchers who coded for themes. An iterative process was used to achieve consensus. Grounded theory was used to interpret data and to derive a theoretical framework for understanding the reasoning that influences episiotomy practice.
a high volume delivery unit in Singapore.
20 of 79 licensed midwives, aged 28-70, who performed independent deliveries at the delivery unit.
participants recognised maternal, fetal and other factors affecting their own decision to perform episiotomies. Patient request, better healing, midwife's reputation and job satisfaction were cited as main reasons to avoid episiotomy. Key sources informing practice were past training, delivery experience, anecdotal learning and lack of a protocol. There was no consensus on current trends in episiotomy practice. There was an absence of recognition of individual roles in reducing episiotomy rates. Clinicians were perceived as having both positive and negative influence.
midwives' reasons for performing episiotomies were attributed to midwifery training, fear of doing harm and perceived clinician expectation, and were not consistent with current international practice guidelines. Reasons for avoiding episiotomies were associated with patient-centeredness and job satisfaction. Midwives agreed on the need to reduce episiotomy rates.
with reduction in episiotomy rates as a goal, a combination of guideline education, feedback, peer coaching and collaborative care with doctors may be needed to achieve desired outcomes. Views and experiences of midwives should also be incorporated into strategies to change episiotomy practice.
探索助产士施行或避免会阴切开术的原因，以及在一家大型三级妇产医院改变会阴切开术实践的动机。
使用目的抽样法，进行了三次焦点小组讨论以达到主题饱和。开放性问题引出了施行或避免会阴切开术的个人原因、信息来源，以及对过去和未来实践趋势的看法。会议进行了录音，三位研究人员独立检查了记录，并对主题进行了编码。使用迭代过程达成共识。扎根理论用于解释数据，并为理解影响会阴切开术实践的推理提供理论框架。
新加坡一家高容量分娩单位。
在分娩单位独立分娩的 79 名持照助产士中有 20 名参加，年龄 28-70 岁。
参与者认识到影响其自身施行会阴切开术决定的产妇、胎儿和其他因素。避免会阴切开术的主要原因是患者的要求、更好的愈合、助产士的声誉和工作满意度。关键的实践信息来源是过去的培训、分娩经验、传闻学习和缺乏协议。目前会阴切开术实践趋势没有共识。没有认识到减少会阴切开术率的个人作用。临床医生被认为既有积极的影响，也有消极的影响。
助产士施行会阴切开术的原因归因于助产士培训、害怕造成伤害和感知到的临床医生期望，与当前国际实践指南不一致。避免会阴切开术的原因与以患者为中心和工作满意度有关。助产士一致认为需要降低会阴切开术率。
以降低会阴切开术率为目标，可能需要结合指南教育、反馈、同行指导和与医生的协作护理，以实现预期结果。还应将助产士的意见和经验纳入改变会阴切开术实践的策略中。
