Understandings of episiotomy guidelines and second-stage perineal practices among midwives in Lagos, Nigeria.

Abstract

Background: Second-stage perineal practices are potentially associated with significant pelvic floor consequences which can impact women’s quality of life.
Aim: This study describes midwives’ understandings of episiotomy guidelines and perineal practices in the second stage of labour.
Methodology: A cross-sectional survey of nurses at a tertiary hospital using structured self-administered questionnaires. Socio-demographic and professional characteristics; knowledge of episiotomy guidelines and second-stage perineal practices were assessed. Data were analysed with SPSS version 20.0 software
Results: Of the 280 nurse participants, 31.8% were aged 40-49years; 65% had post-basic or bachelor of nursing qualifications, and 71.8% had at least 6-10years of labour ward experience. Nearly all mentioned thick inelastic perineum, avoidance of 3rd and 4th-degree tears and instrumental delivery as recommended indications for episiotomy. About a third(37.5%) administered episiotomy to nulliparous women more than 60% of the time; the mediolateral type was given by 87.3% but fewer (73%) knew it as recommended. About 50% obtained clients’ consent while only 32.5% administered analgesia. The majority(91.8%) practised hands-on perineum for perineal protection. Overall, 92.5% had average to good knowledge of episiotomy guidelines. However, 65.7% had good second-stage perineal practices which were significantly associated with midwives’ designations(p=0.002), duration of nursing experience(p<0.001) and knowledge of episiotomy guidelines(p<0.001). Inadequate training in perineal protection techniques; impatience with fetal head at crowning and fear of perineal lacerations were reasons given for liberal episiotomy use.
Conclusion: Midwives’ knowledge of current episiotomy guidelines is reasonable. However, perineal practices need to be improved to reflect evidence-based recommendations.