An assessment of the knowledge and practice of registered midwives regarding policy guidelines for routine episiotomies at two academic, state tertiary hospitals in the Western Cape.

Abstract

An episiotomy is the surgical incision of the perineum. As far is known, was this procedure was done as early as 17 41. Sir Fielding Quid, was the first person to describe this procedure in his "Treatise of Midwifery in Three parts", as an aid to assist with difficult deliveries. The implementation of this intervention is a worldwide phenomenon and has been recorded during the 19th century as one of the most common surgical procedures in the clinical practice. The World Health Organisation has taken a clear stand against routine episiotomies and recommend that episiotomy rates should be around 10% and no more than 20%. There are no clear guidelines in the literature available that give true and valid indications for the performance of an episiotomy. Aim The aim was to determine whether the two tertiary academic institutions in the Western Cape have policies and guidelines available regarding the performance of episiotomies by registered midwives and to determine the knowledge and practice of registered midwives regarding these policies and Methodology The researcher made use of a descriptive survey to explore the issue whether guidelines exist regarding episiotomies and whether midwives are aware about these guidelines. Structured questionnaires were used to gain information from the registered midwives. The researcher also made use of documents (birth register) and in-depth interviews (unit managers). Results The findings of the study concluded that midwives are aware of the latest evidence that episiotomies are not done routinely even though no evidence of existing policies could be allocated in any of the two wards. The finding further shown that the current guidelines are not based on evidence. Midwives do not directly rely on guidelines in the wards (non available), but an inference is made that the midwives obtain access via secondary sources such as obstetricians. Midwives feels competent to do episiotomies but would like to be updated on knowledge regarding procedures and agree that skills updates are important. They are not aware of how to gain access to evidence based literature such as systematic reviews. Conclusions There is an urgent need to inform the regulatory professional body to review their regulations as the current regulation as it stands promotes more harm than good. Similarly is there a need to inform the national, provincial and local government I institutions, that if they publish guidelines they need to ensure that these guidelines are based on the latest evidence where possible. It is further important that policies be available to all members of staff to update them self with current information. In-service updates on evidence.