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 degrees 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.