Using evidence to reduce the rate of episiotomy in a Dubai Hospital

Background. A retrospective survey of birth statistics in Al Wasl Hospital in Dubai in 2006 found that episiotomy was routinely performed on a wide range of women including primigravida, women who had instrumental deliveries, pregnancies with abnormal presentation, fetal distress, large babies, and multigravida women with a perceived rigid perineum. The rate of episiotomy for all women was 64%. Despite this high rate, five women (0.2%) also suffered third and fourth degree tears. Aim. This study was undertaken to assess the existing practice of performing episiotomy and to develop multidisciplinary evidence-based guidelines, which could be introduced to change practice around the routine use of episiotomy. Methods. A review of the literature was undertaken, which questioned the use of routine episiotomy. The authors set out to change practice by utilising a systematic quality improvement model called FOCUS-PDCA, a nine-step process guide to improving quality. By using this model and engaging with medical and midwifery staff, guidelines were produced. Findings. As a result of cooperation and compliance from all staff, the rate of episiotomy fell from 64% in 2006 to less than 20% in 2008, with no increase in the incidence of third-and fourth-degree tears.