Hospital slashes episiotomy rate

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Staff at Al Wasl Hospital in Dubai have dramatically cut their episiotomy rates.

Healthcare staff at a women and childrens hospital in the United Arab Emirates (UAE) have slashed the rate of episiotomies by three quarters, new figures have shown.

Episiotomies performed in the delivery unit at Al Wasl Hospital in Dubai have been cut from 64% to 17% in just one year, according to director of nursing Alison Ramsay.

The reduction was seen after the implementation of evidence based guidelines, restricting the practice of 'cutting', alongside an educational programme for staff.

The rate had dipped as low as 15% in some months, just 1% higher than levels recommended by the World Health Organisation, Ramsay added.

'It's been achieved as a result of great team work. International standards say that episiotomy should be restrictive and only used to speed up delivery because the baby is distressed, or when there is a medical indication - and that's what we have implemented," she said.

One of the key obstacles to decreasing the episiotomy rate was fear among delivery staff that allowing the perineum to tear would led to more post-delivery complications, added Ebenezer Ellen Benjamin, nurse supervisor in the delivery suite.

"Initially there was some resistance, especially when it was a first time delivery. They would say they have to cut because the woman needed space. So I sat with them and counselled them, even in terms of saying it is my responsibility, do not worry about the tears," said Benjamin, the project lead.

Notes were made each month on which staff performed episiotomies. Telephone counseling was then offered to each, to talk through their reasoning.

"They are excited now about our success. They see the complications of episiotomy are more than tears. We are striving to reach 14%," she added.

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