Clinical decision making and factors associated to episiotomy: cross-sectional study

• Grant number: 13/16063-1
• Support Opportunities: Regular Research Grants
• Start date: February 01, 2014
• End date: January 31, 2015
• Field of knowledge: Health Sciences - Nursing - Obstetrical Nursing
• Principal Investigator: Flora Maria Barbosa da Silva
• Grantee: Flora Maria Barbosa da Silva
• Host Institution: Escola de Artes, Ciências e Humanidades (EACH). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Several studies has showed that the routine use of episiotomy is not of benefit to women that it might, in the immediate postpartum period, cause pain, discomfort, limit the activities of women and negatively impact the experience of motherhood. Long-term follow-ups have associeted episiotomy to cosmetic and sensitivity changes of the perineal region. Studies also show that episiotomy is associated with urinary and fecal incontinence, decreased sexual desire, decrease arousal and vaginal lubrication and the occurrence of dyspareunia. Despite the fact that current evidence recommends that this intervention should be performed only when there are clear maternal or fetal indications, episiotomy rates in deliveries of Brazilian women are around 70%, as reported by the Demography and Health of women and children National Research (PNDS 2006). However, in maternity services where women receive care during labor from nurse-midwives and midwives, episiotomy rates are lower than the national average, ranging from 40.4% to 25.7% and 12.9%. Therefore, the investigation of the reasons for the clinical decision to perform an episiotomy may be carried out in a maternity service where normal deliveries are assisted only by professionals performing the procedure in a selective approach. This may contribute to the development of strategies to prevent this procedure and to increase rates of perineal integrity among women who have vaginal deliveries. Objective: To analyze the factors associated with the clinical decision to performing an episiotomy and the factors associated to the perineal condition of women attended by nurse-midwives, in a birth center. Method: This study is a cross-sectional study with prospective data collection, to be conducted from September 2013 to September 2014, in the Maternity Hospital Leonor Mendes de Barros, located in the city of São Paulo. Data on socio-demographic variables, medical and obstetric history of women and maternal and neonatal outcomes will be collected in an encoded form. It was not possible to perform a sample size calculation, as there is no information on the prevalence of factors associated with episiotomy in this service. From October 2011 to November 2012, 1,564 women were assisted in this service, therefore it is expected that at least 1,000 women will be included in this study. The database will be constructed using the Epi-Data program. For statistical analysis, a logistic regression model will be constructed, in order to identify factors independently associated with the decision to perform an episiotomy. This project was submitted to the Ethics Committee of the School of Arts, Sciences and Humanities, University of São Paulo. (AU)