PICOT Question
An episiotomy is a surgical incision in the vagina that attempts to make extra space for the baby to emerge. The goal of medical practice is to facilitate a quicker delivery. The practice emerged in the 1700s on the ground of being useful for problematic deliveries, especially when a woman could not push the baby after it was properly positioned in the vagina. As of 1979, 69 percent of women received episiotomy as a standard of care during delivery. The method, however, decreased during the 2000s, and as of 2004, only 25 percent of women underwent the procedure (Kartal et al., 2017). A recommendation in contrast to routine episiotomy was issued by the American College of Obstetricians and Gynecologists (ACOG) in 2006. The number of women of underwent the procedure during delivery was less 12 percent in 2014 (Wiener, 2016).
Despite the fall in a number of women undergoing episiotomy, there is an increased concern that it causes vaginal and perineal tearing. Applying the picot question: Women admitted into the maternity ward for delivery (P), does undergoing episiotomy among laboring women (I) increase the risk of vaginal and perineal tearing (O) compared to laboring women who do not undergo the procedure (C) in an evaluation after a 12-month period (T). The Picot question intends to interpret the use of evidence-based research to support the recommendation against the routine practice of episiotomy.
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Literature Search
Several studies were identified as being beneficial to answering the Picot Question. Jiang et al. (2017), Kartal et al. (2017) and Shmueli et al. (2016) were identified as quantitative studies. The qualitative research articles include Raisanen et al. (2010), Manzanares (2013) and Melo et al. (2014). The articles expound on the practice of episiotomy and the effects it has on women during delivery. The articles will help identify the effects of the practice as well and ways to improve outcomes.
References
Jiang, H., Qian, X., Carroli, G., & Garner, P. (2017). Selective versus routine use of episiotomy for a vaginal birth. Cochrane Database of Systematic Reviews . doi:10.1002/14651858.cd000081.pub3
Kartal, B., Kızılırmak, A., Calpbinici, P., & Demir, G. (2017). Retrospective analysis of episiotomy prevalence. Journal of the Turkish-German Gynecological Association , 18 (4), 190-194. doi:10.4274/jtgga.2016.0238
Manzanares, S., Cobo, D., Moreno‐Martínez, M. D., Sánchez‐Gila, M., & Pineda, A. (2013). Risk of episiotomy and perineal lacerations recurring after the first delivery. Birth , 40 (4), 307-311. doi:10.1111/birt.12077
Melo, I., Katz, L., Coutinho, I., & Amorim, M. M. (2014). Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trial. Reproductive Health , 11 (1), 66. doi: 10.1186/1742-4755-11-66
Räisänen, S., Vehviläinen-Julkunen, K., & Heinonen, S. (2010). Need for and consequences of episiotomy in vaginal birth: a critical approach. Midwifery , 26 (3), 348-356. doi:10.1016/j.midw.2008.07.007
Shmueli, A., Gabbay Benziv, R., Hiersch, L., Ashwal, E., Aviram, R., Yogev, Y., & Aviram, A. (2016). Episiotomy – risk factors and outcomes. The Journal of Maternal-Fetal & Neonatal Medicine , 30 (3), 251-256. doi:10.3109/14767058.2016.1169527
Wiener, J., (2016, July 4). Episiotomies Still Common During Childbirth Despite Advice To Do Fewer. Retrieved from https://www.npr.org/sections/health-shots/2016/07/04/483945168/episiotomies-still-common-during-childbirth-despite-advice-to-do-fewer
