Lisa Kane Low received a BSN from the University of Michigan and a masters degree from the University of Illinois at Chicago. She has been in clinical midwifery practice at Hutzel Hospital in Detroit Michigan and currently is a member of the Nurse-Midwifery Service at the University of Michigan Health System. She also teaches in the School of Nursing and Women's Studies Program and is completing her doctoral studies in women's health and women's studies at the University of Michigan.
CLINICIAN-SPECIFIC EPISIOTOMY RATES: IMPACT ON PERINEAL OUTCOMES
Version of Record online: 26 JAN 2011
2000 American College of Nurse Midwives
Journal of Midwifery & Womens Health
Volume 45, Issue 2, pages 87–93, March-April 2000
How to Cite
Low, L. K., Seng, J. S., Murtland, T. L. and Oakley, D. (2000), CLINICIAN-SPECIFIC EPISIOTOMY RATES: IMPACT ON PERINEAL OUTCOMES. Journal of Midwifery & Womens Health, 45: 87–93. doi: 10.1016/S1526-9523(00)00003-9
- Issue online: 26 JAN 2011
- Version of Record online: 26 JAN 2011
Recent, large, randomized, controlled trials of the effects of episiotomy on perineal damage have confirmed that episiotomy is associated with an increased risk of damage to the perineum. Yet episiotomy remains the most common surgical procedure women undergo. This article examines if clinician experience, rather than scientific evidence, forms the basis for continuing this practice. Perineal outcome data are analyzed for 865 low-risk women who were attended at birth by the staff nurse-midwives or faculty obstetricians at a university-based, tertiary-care hospital. Data were collected under routine, non-experimental conditions such that the circumstances of the labor and the clinician's preferences were allowed to determine management decisions regarding the use of episiotomy or other techniques of perineal management. Multivariate findings indicate that in the absence of episiotomy, rates of perineal integrity were highest among clinicians who usually had the lowest rate of episiotomy use. When an episiotomy was done, rates of third- and fourth-degree extensions were highest among clinicians who used episiotomy most frequently. This finding challenges the idea that clinicians who were very experienced with the use of episiotomy would avoid complications such as extensions. Future research should explore the use of nonsurgical techniques such as those employed by midwives to promote perineal integrity. Then interdisciplinary research and evidence-based education regarding these techniques can occur to improve perineal outcomes for all women.